• 1

    Personal Information

  • 2

    Vehicle Information

  • 3

    Coverage & Submit


Personal Information

First Name*
Last Name*
Personal Email*
Phone Number*
Are you affiliated with US/NATO Forces?* YesNo
Where will the vehicle be registered?* USAREURGerman registry
Duty Station/Location in Germany*
Are you married?* YesNo
Date of Birth*

Are you currently insured with GEICO?YesNo
GEICO policy number
Car Make*
Car Model*
Year of Vehicle*
VIN - Vehicle Identification Number
Horse Power
Actual Cash Value in USD* (max. value 95,000 USD)
2nd Driver Information
2nd Driver First Name
2nd Driver Last Name
Is there a lien on your vehicle?YesNo
Lienholder Name:
Lienholder Address:
Have you had any at-fault accidents in the last five years?YesNo

Third Party Liability Insurance incl. Motor Assistance Coverage (mandatory)*
Comprehensive Coverage (e.g. theft, broken windshield, natural hazard) Deductible 300 EUR*
Collision Coverage (own damage) Deductible 500 EUR (Note: If you select to have Collision Coverage, you will also carry Comprehensive Coverage with a 300 EUR deductible)*
Loyalty Repair Program?*
Effective Date of Coverage*
I hereby consent to my data submitted in the contact form being collected and processed in order to answer my request.