Car insurance only questionnaire

                         ( please scroll down )

                     " It's all about trust "

Please neatly complete this form and fax or email it back to my office.

  T-you chris  

Office (678) –560–2525    email   csmith7750@yahoo.com    fax(770) 321 -1671

                 ANSWER ALL  QUESTIONS BELOW AND RETURN

Related to car insurance

current day and evening and cell  phone number

    current e-mail address

 Current home address

  ALL drivers in the  household  requested information

Legal complete name exactly as listed on drivers licence

Dates of birth and social security number of each driver.

Drivers license numbers for each driver reflecting the last three years

 include the State with the numbers.

==Tickets( any moving violations) and any claims (whether your fault or not )

 in the last 3 years for all drivers in home

          ==each  Drivers dates of birth  andsocial security numbers of all    drivers in the household

 =serial / vin numbers of each  car in the household /

   confirm with the registration or from dashboard of car  

                                      current car insurance companies name and policy number

                                           Finance / lease company’s name & address if applicable

IMPORTANT  Please include a copy of a current car’s proof of insurance (declaration page)

                   shows all cars & coverage’s