Antique quotation

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VEHICLE AND INSURED INFORMATION

Vehicle type

Year

Make

Model

Cylinders

Original engine

Antitheft system

Purchase price or vehicle value (taxes included)

.00 $

Year of purchase

Year of birth

Zip code

Phone number

First name

Last name

	1 800 567-0927
	info@leclercassurances.com
	leclercassurances.com

*This is a general description of guidelines and coverage. Hagerty reserves the right to determine final risk acceptance. All coverage is subject to policy provisions, exclusions, and endorsements.