JT kia Insurance Services.
Full Name:
Home Address:
E-mail ,Telephone Number.
Please answer the following questions and submit it . We will e-mail or telephone your quote to you.
Auto 1, Year & Model
Auto 2, Year & Model
Auto 3, Year & Model
Driver 1, Name
Driver 2, Name
Driver 3, Name
Driver 1, License #
Driver 2, License #
Driver 3, License #
Driver 1, Years Licensed
Driver 2, years Licesnsed
Driver 3, Years Licensed
Driver 1,Accidents,Tickets in past 3 years.
Driver 2, Accidents.Tickets in past 3 years.
Driver 3, Accidents, Tickets in past 3 years.
Auto 1 Vin #
Auto 2, Vin #
Auto 2, Vin #
Bodiy Injury and Property Damage.
Uninsured Motorist Bodily Injury.
Uninsured Motorist Propery Damage.
Comprehensive Ded.
Collision Ded.
Towing  Yes, or NO.
Rental Car. Choose one , $25, or $50 per day
Does your car has following$ 1-Anit Lock Brake , 2-Air Bags, 3-Lojack alarm.
Do you use your car for business, , commute, or pleasure?
How many miles one way to work ?
How many miles per year
What is your Current Insurance company, and how long do you have insurance.
Thank you for taking time for  completing  this