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  1. To get a quote for a car insurance, please complete the form below..
  2. Your Full Name(*)
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  3. E-mail(*)
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  4. Phone number
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  5. Profession
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  6. Full address
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  7. Date of birth(*)
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  8. Driver license since (year)
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  9. No-Claim Certificate (# years)
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  10. About the car
  11. Brand
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  12. Model
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  13. Engine power (KW)
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  14. Construction year
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  15. Number of seats
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  16. Catalogue value (without VAT)
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  17. Invoice price (without VAT)
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  18. How much is five + 3 ?(*)
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    (antispam control)
  19.   
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Address:
St Annalaan, 209 B-1853 Strombeek-Bever
Tel: +32 2 267.92.26
Fax: +32 2 267.28.32
FSMA 020259 A-cB
Email: expatinsurance@copper.be