Mexican Registered Vehicle Insurance — Quote Request

Please complete the Mexican Registered Vehicle Insurance Quote Request form below.

Step 1 - Vehicle Info

* Year:

* Make:

* Model:

* Vehicle ID (VIN #):

* License Number:

* License State:

* License Territory:

* Coverage Type: Full Coverage Liability Only If "Full Coverage", please list the current market value of your vehicle below.

Current Market Value: Don't know the current market value? Visit Kelly Blue Book. Fill in for Full Coverage only.

Step 2 - Coverage Start

* Requested Start Date of Policy: Date may not be prior to today.

Step 3 - Customer Info

* First Name:

Middle Name:

* Last Name:

* Date of Birth:

Company:

* Street:

* City:

* State/Province/Region:

* Zip/Postal:

* Country:

* Phone:

Fax:

* Email:

* Drivers License Number:

* Drivers License State:

Other Drivers:

* Mexican Address:

* Cuidad:

* Estada:

* Codigo Postal:

Have you previously had a policy with Lewis and Lewis?

Yes:

The completed application must be returned to Lewis and Lewis with a copy of one of the following legal documents:

Tarjeta de Circulacion
Pedimento de Importacion
Factura
Utility bill with name and address in Mexico, not more than 3 months old
CURP: Unique Population Registry Code

Email: INFO@MEXICANAUTOINSURANCE.COM

Fax: (310) 207-7701

Lewis and Lewis Insurance Agency, Inc.
11900 West Olympic Blvd. #475
Los Angeles CA 90064

Please be aware that 3-5 days of processing time is required after your request for a Mexican Registered Vehicle Tourist Insurance quote. Our hours are Monday through Friday, 8:00 AM - 4:00 PM (Pacific Standard Time).

If you have any further questions, please
call us at:

(800) 966-6830 or (310) 207-7700