Insured name | {% if companyName !="" %} {{ companyName }} & [[fields.additionalInsuredName]] {% else %} {{ insuredName }} & [[fields.additionalInsuredName]] {% endif %}

To renew | [[arrayToObjectJs.insuranceCompany]] - [[renovation]] - [[lastPlan]] - $[[lastTotalPremium]] USD

Tourist Auto Multi-Quoter

{% if distributorId is not defined %}

Simulate as: (Only if you need to refer a distributor) {{ form_widget(form.simulateDistributorId) }}

{% endif %}

Type* {{ form_widget(form.vehicleType) }}

Model year* {{ form_widget(form.modelYear) }}

Is the vehicle Electric or Hybrid?* {{ form_widget(form.isElectricOrHibrid) }}

Any driver under the age of 21?* {{ form_widget(form.driverUnder21) }}

Policy term* {{ form_widget(form.term )}}

Territory {{ form_widget(form.territory) }}

Liability* {{ form_widget(form.liability) }}

Car value* {{ form_widget(form.carValue )}}

Towing value(Optional) {{ form_widget(form.towingValue) }}

Entrance date* {{ form_widget(form.entranceDate) }}

Choose the coverage to continue.

Edit Quote

	Full Coverage	Standard Coverage	Full Liability

Company benefit comparison

{# #}

[[ plan ]]		Back arrow_back
Territory:
Coverages / Coberturas	Sum assured / Suma asegurada	Deductible / Deducible	Sum assured real / Suma asegurada real	Net premium / Prima neta

Save or send a quote

Select the company for the quote:

Full Coverage

Standard Coverage

Full Liability

Client email
[[ fields.email ]]

Nationality* {{ form_widget(form.nationality) }}

Driver license* {{ form_widget(form.identificationNumber) }}

Occupation* {{ form_widget(form.occupationAux) }}

Country* {{ form_widget(form.country) }}

Postal code* {{ form_widget(form.postalCode) }}

State* {{ form_widget(form.state) }}

City* {{ form_widget(form.city) }}

Address* {{ form_widget(form.address) }}

Make* {{ form_widget(form.brand) }}

Model* {{ form_widget(form.subBrand) }}

VIN* {{ form_widget(form.serialNumber) }}

Plates* {{ form_widget(form.plates) }}

Towing serial number* {{ form_widget(form.towingSerialNumber) }}

Towing plates* {{ form_widget(form.towingPlates) }}

Additional insured (Remove if not required) {{ form_widget(form.additionalInsured) }}

Lienholder name (Optional) {{ form_widget(form.lienholder) }}

Lienholder address {{ form_widget(form.lienholderAddress) }}

How did you hear about us?* {{form_widget(form.aboutUsList)}}

Insured information
Name	[[ fields.firstName ]] [[ fields.lastName ]] [[ fields.motherLastName ]] & [[ fields.additionalInsuredName ]]
Birthday	[[ fields.birthday ]]
Email	[[ fields.email ]]
Phone	[[ fields.phone ]]
Address	[[ fields.street ]] , [[ fields.city ]], [[ fields.state ]], [[ countryFilter(fields.country) ]]
Vehicle information
Description	[[ fields.make ]], [[ fields.model ]], [[ fields.modelYear ]]
Vin	[[ fields.vin ]]
Plates	[[ fields.plates ]]
Towing information
Towing VIN	[[ fields.vin ]]
Towing Plates	[[ fields.plates ]]
Policy
Lienholder	[[ fields.lienholder ]]
Lienholder address	[[ fields.lienholderAddress ]]
Plan	[[ plan ]]
Term	[[ fields.term \| termFormat ]]
Territory	[[ fields.territory \| territoryFormat ]]
Liability	$[[ fields.liability \| currencyFormat ]] USD
Total premium $[[ price ]] USD
These policies are non-cancellable and premiums are fully earned at time of purchase.

{% if distributorType is defined and distributorType == 'Producer US' %} {% include 'distributors/broker-fee-inputs.twig' with {'distributorType': distributorType} %} {% endif %}

Card holder first name* {{ form_widget(form.cardFirstName) }}

Card holder last Name* {{ form_widget(form.cardLastName) }}

Carrier* {{ form_widget(form.cardType) }}

Credit card number* {{ form_widget(form.cardNumber, {'attr':{'style':'margin-bottom:4px !important;'}} ) }} Visa, Master card, American Express, Discover, JCB cards

Expiration month* {{ form_widget(form.cardExpirationMonth) }}

Expiration year* {{ form_widget(form.cardExpirationYear) }}

Security code* {{ form_widget(form.cardCcv) }}

{# {{ include('preloader.twig') }} #}

{{ form_rest(form) }} {# id de distribuidor #} {% if distributorId is defined %} {% endif %} {# si viene con esta variable, es una cotizacion cargada #} {# {{ form_widget(form.option) }} #}

{% if paymentTypeMode == 'CreditCard' or paymentTypeMode == 'All' %} Credit Card Payment {% endif %}

{% if paymentTypeMode == 'WithoutOutCharge' or paymentTypeMode == 'All' %} Bank transfer {% endif %}

{# {{ include('mx/modals/modal-toursit-auto-qualitas-ws.html.twig') }} #}