Quotes

730 Birginal Drive
Bensenville, Illinois 60106
Toll Free 888.345.2700
Fax 630.616.1705

> Quotes

For Insurance Companies Only

Please fill out blanks with as much of the model numbers as you can.
C.I.S. claim handlers are experts at figuring out incomplete equipment information.

There is no charge for a standard quote.

*Claim #:
Insured Name:
*Adjusters Name and/or Team #:
*Adjusters and/or Team Phone Number: (ex. 847-555-1212)
Type of Car (for verification reasons):

Please indicate if you want the quote Called, Faxed or E-mailed back to you. Call Fax E-Mail

Fax #: or
E-Mail Address:

Equipment:

Radio            Cassette    Cassette/CD      CD      DVD     Minidisk   Navigation
                                   Manufacture:
                                    Model #:

Equalizer Manufacture:
Model #:

Video Type:

CD Changer Manufacture:
Model #:

Processors: Type:

Amplifier (1): Manufacture:
Model #:

Amplifier (2): Manufacture:
Model #:

Speakers (1): Manufacture:
Model #:

Speakers (2): Manufacture:
Model #:

Woofers             Qty:
                                  Manufacture (1):
                                  Manufacture (2):
                                  Model #(s):

Enclosures

If additional equipment quotes are needed please include that information here: