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Insured

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Secondary/Additional Driver

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Current Registration

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Get in Touch

CONTACT US

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Location

37 W Burnside

Bronx, NY 10453

underwriting@ezvbrokerage.com

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Personal Auto Quote

Insured Name

Email

Phone Number

Drivers License Number

State

Upload File

Additional Operator Information

(Not required)

Name

Drivers License Number

State

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Relationship to Insured

Vehicle (Make & Model)

Vehicle Year

Vehicle VIN Number

Please upload one of the following for each vehicle:

  • Current Registration

  • Purchase Document

  • Bill of Sale

  • Vehicle Title

  • NYS Insurance ID Card

Upload File

By using our website, you agree to these terms and conditions.

  1. Services: We provide a form to obtain insurance quotes from various providers.

  2. Accuracy of Information: You are responsible for providing accurate information.

  3. Privacy: We will handle your personal information in accordance with our privacy policy.

  4. Liability: We are not liable for losses, damages, or expenses resulting from your use of our website or any errors.

  5. Indemnification: You agree to indemnify us from any losses resulting from inaccurate information you provide.

  6. Intellectual Property: Our website content is our property and may not be reproduced without permission.

  7. Governing Law: These terms and conditions are governed by the laws of our jurisdiction.

  8. Changes: We may make changes to these terms and conditions at any time.

  9. Contact: Contact us if you have any questions or concerns.

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