Commercial Auto Form | News Insurance

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Commercial Auto Information
Contact Information
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Please answer the questions with the best of your knowledge. After you submit the information our account representative will get quotes with multiple carriers and will send provide your proposal. If this is urgent or you have any question please call us. We will be more than glad to help you.

Owner-President Name:

Address:

City

State

Zip Code

Day Phone:

Email:

Cell Phone:

Type of Commercial Auto Insuarnce:

Currently Insured:

Proposed effective date:

Number of total years continuously insured:

Name of most current insurance company:

Business Name

Incorporation Type:

Type of Commercial Vehicle:

Type commercial trailers (if Any):

Buisness Description

Describe business operation:

No of Employees:

Annual gross Income:

Vehicle Details

No of Commercial Vehicle to be covered:

Radius of Operation:

Number of Accidents / Claims (Last 3-Years):

Give Deatils of Claims (Last 3-Years):

Number of minor MOVING violation convictions (past 3 years):

Any Filings Required:

Filing # USDOT Filing # MC#:

Vehicle Auto Liability Limit:

Physical Damage Coverage for all Vehicle:

Vehicle No-1 Year:

Vehicle No-1 Model:

Vehicle No-1 VIN Number:

Vehicle No-1 Anti Theft Device:

Driver 1 Name:

Driver 1 Driving License No:

Driver 1 Driving License Class:

Driver 1 Date of Birth (mm/dd/yyyy):

Enter Additional Vehicle Details for 5 and more vehicles (Year, Model, VIN):

Enter additional Drivers Details, if any (Name, DL Number, DL Class, Date of Birth):