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Japanese Sentence with English Translation

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Could I write down your name, address and phone number, for the insurance company?
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Vocabulary list

hokengaisha
noun
  1. insurance company
hoken
noun, no adjective
  1. insurance; guarantee
kaisha
noun
  1. company; corporation
  2. workplace
ni
particle
  1. at (place, time); in; on; during
  2. to (direction, state); toward; into
  3. for (purpose)
  4. because of (reason); for; with
  5. by; from
  6. as (i.e. in the role of)
  7. per; in; for; a (e.g. "once a month")
  8. and; in addition to
  9. if; although
renraku
noun, suru verb
  1. contacting; (making) contact; getting in touch; communication; correspondence; call; message
  2. connection (with a train, bus, etc.); joining (a railway line, etc.); meeting
  3. connection (between matters, incidents, etc.); relation; link
suru

Polite Present Indicative Form

shimasu
suru verb (irregular)
  1. to do; to carry out; to perform
  2. to cause to become; to make (into); to turn (into)
  3. to serve as; to act as; to work as
  4. to wear (clothes, a facial expression, etc.)
  5. to judge as being; to view as being; to think of as; to treat as; to use as (as 〜にする,〜とする)
  6. to decide on; to choose (as 〜にする)
suru verb (irregular), intransitive verb
  1. to be sensed (of a smell, noise, etc.) (as 〜がする)
  2. to be (in a state, condition, etc.)
  3. to be worth; to cost
  4. to pass (of time); to elapse
suru verb (irregular), transitive verb
  1. to place, or raise, person A to a post or status B (as AをBにする)
  2. to transform A to B; to make A into B; to exchange A for B (as AをBにする)
  3. to make use of A for B; to view A as B; to handle A as if it were B (as AをBにする)
  4. to feel A about B (as AをBにする)
suffix, suru verb (irregular)
  1. verbalizing suffix (applies to nouns noted in this dictionary with the part of speech "vs")
auxiliary verb, suru verb (irregular)
  1. creates a humble verb (after a noun prefixed with "o" or "go")
  2. to be just about to; to be just starting to; to try to; to attempt to (as 〜うとする,〜ようとする)
node
particle
  1. that being the case; because of ...; the reason is ...; given that ...
go
prefix
  1. honorific/polite/humble prefix (usu. before a term with an on-yomi reading)
suffix
  1. honorific suffix (after a noun indicating a person)
namae
noun
  1. name
  2. given name; first name
to
particle, conjunction
  1. if; when
  2. and
particle
  1. with
  2. used for quoting (thoughts, speech, etc.)
noun
  1. promoted pawn
particle
  1. indicates a question (at sentence end)
go
prefix
  1. honorific/polite/humble prefix (usu. before a term with an on-yomi reading)
suffix
  1. honorific suffix (after a noun indicating a person)
juusho
noun
  1. address (e.g. of house); residence; domicile
to
particle, conjunction
  1. if; when
  2. and
particle
  1. with
  2. used for quoting (thoughts, speech, etc.)
noun
  1. promoted pawn
particle
  1. indicates a question (at sentence end)
odenwa
noun
  1. telephone call
  2. telephone (device)
o
prefix
  1. honorific/polite/humble prefix (usu. before a term with a kun-yomi reading; おん is more formal)
denwabangou
noun
  1. telephone number
denwa
noun, suru verb, no adjective
  1. telephone call; phone call
noun, no adjective
  1. telephone (device); phone
bangou
noun
  1. number; series of digits
wo
particle
  1. indicates direct object of action
  2. indicates subject of causative expression
  3. indicates an area traversed
  4. indicates time (period) over which action takes place
  5. indicates point of departure or separation of action
  6. indicates object of desire, like, hate, etc.
kiroku
noun
  1. record; minutes; document
  2. record (e.g. in sports); results; score
suru verb
  1. to record; to document
  2. to set a record (e.g. in sports); to show a result; to reach a value
saseteitadaku

Potential Polite Present Indicative Form

saseteitadakemasu
expression, godan verb
  1. to have the privilege of doing
suru

Causative Plain te-form

sasete
suru verb (irregular)
  1. to do; to carry out; to perform
  2. to cause to become; to make (into); to turn (into)
  3. to serve as; to act as; to work as
  4. to wear (clothes, a facial expression, etc.)
  5. to judge as being; to view as being; to think of as; to treat as; to use as (as 〜にする,〜とする)
  6. to decide on; to choose (as 〜にする)
suru verb (irregular), intransitive verb
  1. to be sensed (of a smell, noise, etc.) (as 〜がする)
  2. to be (in a state, condition, etc.)
  3. to be worth; to cost
  4. to pass (of time); to elapse
suru verb (irregular), transitive verb
  1. to place, or raise, person A to a post or status B (as AをBにする)
  2. to transform A to B; to make A into B; to exchange A for B (as AをBにする)
  3. to make use of A for B; to view A as B; to handle A as if it were B (as AをBにする)
  4. to feel A about B (as AをBにする)
suffix, suru verb (irregular)
  1. verbalizing suffix (applies to nouns noted in this dictionary with the part of speech "vs")
auxiliary verb, suru verb (irregular)
  1. creates a humble verb (after a noun prefixed with "o" or "go")
  2. to be just about to; to be just starting to; to try to; to attempt to (as 〜うとする,〜ようとする)
itadaku

Potential Polite Present Indicative Form

itadakemasu
godan verb, transitive verb
  1. to receive; to get; to accept; to take; to buy
  2. to eat; to drink
  3. to be crowned with; to wear (on one's head); to have (on top) (orig. meaning)
  4. to have (as one's leader); to live under (a ruler); to install (a president)
auxiliary verb, godan verb
  1. to get somebody to do something (follows a verb in "-te" form)
ka
particle
  1. yes?; no?; isn't it?; is it? (used at sentence-end; indicates a question (sometimes rhetorical))
  2. or; whether or not (after each alternative)
  3. some- (e.g. something, someone) (after an interrogative)
  4. hmm; huh (indicates doubt, uncertainty, etc.; sometimes after other particles)
prefix
  1. very (emphatic prefix; usu. before an adjective)
suffix
  1. -al; -ial; -ic; -ical; -ish; -y (suffix forming adjectives or adverbs; after an indeclinable word)
adverb
  1. in that way

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