Home Page Home Page Refer A Friend Search Our Site RSS Facebook Life & Health Insurance Business Insurance Homeowners Insurance Automobile InsurancePre Header
Get A Quote

Auto Quote Form


Fill out the following form as completely as possible. Once you have completed the form, click Submit to send your information to Kris Rogers Insurance Services. We will handle your request shortly.

First Name
Required
Last Name
Required
Street Address
Required
City, State, ZIP Code
Required
  
Phone Number
Required
Ext.
Alternate Number
Optional
Ext.
E-Mail Address
Required
Date of Birth
Required
 /   / 
Marital Status
Required
Gender
Required
Own or Rent Home
Optional
Currently Insured
Optional
If no, when did you last have insurance?
Optional
 /   /  
Current Carrier
Optional
How did you hear about us?
Optional

Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.
Menu Options Kris Rogers Insurance Services
3451 Torrance Blvd Suite 201
Torrance, CA 90503
PH: 310-316-2200
FX: 310-316-0474
kris@krisins.com
LICENSE#: 0D00471

Site Footer
Home Page About Us Get A Quote Contact Us Testimonials Referrals Insurance Agent Websites by Insurance Website Builder