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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

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

Upload File

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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