A. van Leeuwenhoeksweg 50, 2408 AN Alphen aan den Rijn
     
+31 (0)172-449977
    
info@khz.nl
A. van Leeuwenhoeksweg 50, 2408 AN Alphen aan den Rijn   
C
This data will be used for transport insurance purposes only. We request you to submit the catalogue value of your hehicle. Please follow this link for further information.

    Your personal information

    Last name*

    E-mail address*

    Order number*

     

    Description of vehicle

    Type of vehicle
    CARMOTORBIKEMOPEDOther

    Namely

    Make & model

    Year built

    Year purchased

    Vehicle identification number:

    Registration number

    Weight*

    Original catalogue value of vehicle*

    *=required field(s)

    When you use this form, you agree to the storage and processing of your data through this website.