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mexican auto insurance


Instant Mexico Auto Insurance Services
223 Via De San Ysidro
San Ysidro, CA 92173
Toll Free All U.S. & Canada 800-345-4701

GET YOUR FREE NO OBLIGATION QUOTE !!

After completing this form press submit.  We will respond to your form on the next business day via the information you submitted. 
 IF YOU NEED A QUOTE IMMEDIATELY PLEASE CALL 1  800 345-4701.

APPLICATION FOR MEXICAN AUTO INSURANCE:

First Name: Last Name:
Street Address
City State  Zip Code
Work Phone Example: 888 555-1212
Home Phone Example: 888 555-1212
FAX Example: 888 555-1212
E-mail Example: yourname@somewher.com


For Club Membership Discounts please indicate from the list below.


     Membership Number:


Date starting your trip
Date ending your trip

Time you will be crossing the border

Sold in 24 hour increments. Example: If your policy starts at 5:00 am your policy ends on 5:00am on the ending date.

List below the vehicles requesting insurance.

Type of Veh.

Year

 Make

Model
Veh ID #
Trailer
Year
 Make
Model
Veh ID #
Boat
Year
Make
Model
Veh ID #

COVERAGE PLANS
I would like information on the following plans:

For information on types of coverage's go to our Insurance page.

Full Coverage Package includes:

  • Collision

  • Fire & Theft

 

  • Liability - (PD,PL & Medical)

  • Legal Services (optional)

     

Liability Package
 includes:

  • Liability - (PD,PL, Medical)

  • Legal Services (optional)

 

ACTUAL CASH VALUE OF:
(if full coverage is desired) 

Vehicle: $
Example10,200.00

Trailer: $
Example10,200.00

Motorcycle: $
Example10,200.00

For amounts over $50,000.00 in value please insert information in the comment box.

Comments: 

    FISHING PERMIT: One Year:


BOAT PERMIT:
   One Year:      Boat Length:

WE ACCEPT THE FOLLOWING CREDIT CARDS:
VISA, MASTER CHARGE, AMERICAN EXPRESS, DISCOVER.
 

NOTE: This is for quotation purposes only. No coverage is in effect until a policy number has been assigned.


Instant Mexico Auto Insurance.
Copyright © 1999 Instant Mexico Auto Insurance Service. All rights reserved.
Revised: March 24, 2008

Instant Mexico Auto Insurance Services
223 Via De San Ysidro
San Ysidro, CA 92173
(619) 428-4714 or 428-3583

TOLL FREE CALLING ALL U.S. AND CANADA
1-800-345-4701 FAX SERVICE (619) 690-6533
E Mail sales department

Brokers License CA # 0516723

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