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Commercial Auto Insurance Quote

First Name:*

Last Name:*

Business Address:*

Business Name:*

Check if Mailing Address is different from above

Mailing Address: *

Check if Garage Location is different from above

Garage Location: *

Phone Number*

Email Address *

Legal Entity*

Number of Years in Business*

Please give a description of your business operations below:*

Does the risk have or plan on having a US DOT#?:*

Yes

No

US DOT#:*

Are all vehicles registered to the company/corp?:*

Yes

No

Who are they registered to?:*

Are vehicles used for personal use?*

Yes

No

Please describe below:*

Are all the vehicles this entity owns included in this quote request?*

Yes

No

Please advise why: *

Driver 1

Driver Name*

Date of Birth:*

Driver's License No.*

State Licensed:*

Add another driver

Driver 2

Driver Name*

Date of Birth:*

Driver's License No.*

State Licensed:*

Add another driver

Driver 3

Driver Name*

Date of Birth:*

Driver's License No.*

State Licensed:*

Add another driver

Driver 4

Driver Name*

Date of Birth:*

Driver's License No.*

State Licensed:*

Add another driver

Driver 5

Driver Name*

Date of Birth:*

Driver's License No.*

State Licensed:*

Liability Amount (CSL):*

Uninsured Motorist - Bodily Injury (CSL):*

Uninsured Motorist - Property Damage:*

Yes

No

Medical:*

Hired Auto:*

Yes

No

Non-Owned Auto:*

Yes

No

Comprehensive Deductible:*

Yes

No

Please choose one:*

Collision Deductible:*

Yes

No

Please choose one:*

Vechicle 1

Year*

Make*

Model:*

VIN #

Gross Vehicle Weight (lbs)*

Cost New ($)*

Maximum Radius Mileage*

Vehicle Use*

Please describe in detail what the vehicle is used for:*

If commodity is hauled, please explain:

Add another Vehicle

Vechicle 2

Year*

Make*

Model:*

VIN #

Gross Vehicle Weight (lbs)*

Cost New ($)*

Maximum Radius Mileage*

Vehicle Use*

Please describe in detail what the vehicle is used for:*

If commodity is hauled, please explain:

Add another Vehicle

Vechicle 3

Year*

Make*

Model:*

VIN #

Gross Vehicle Weight (lbs)*

Cost New ($)*

Maximum Radius Mileage*

Vehicle Use*

Please describe in detail what the vehicle is used for:*

If commodity is hauled, please explain:

Add another Vehicle

Vechicle 4

Year*

Make*

Model:*

VIN #

Gross Vehicle Weight (lbs)*

Cost New ($)*

Maximum Radius Mileage*

Vehicle Use*

Please describe in detail what the vehicle is used for:*

If commodity is hauled, please explain:

Add another Vehicle

Vechicle 5

Year*

Make*

Model:*

VIN #

Gross Vehicle Weight (lbs)*

Cost New ($)*

Maximum Radius Mileage*

Vehicle Use*

Please describe in detail what the vehicle is used for:*

If commodity is hauled, please explain:

Loss Information

Have you had any losses in the last three years?*

Yes

No

Loss #1

Date of Loss: *

Type of Loss:*

Amount Paid ($)*

Add another loss

Loss #2

Date of Loss: *

Type of Loss:*

Amount Paid ($)*

Add another loss

Loss #3

Date of Loss: *

Type of Loss:*

Amount Paid ($)*

Add another loss

Loss #4

Date of Loss: *

Type of Loss:*

Amount Paid ($)*

Add another loss

Loss #5

Date of Loss: *

Type of Loss:*

Amount Paid ($)*

Additional Comments

Please give any additional comments you feel appropriate for this quotation. If you have additional information where there was not enough fields above, please enter them here.

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Commercial Insurance

Commercial Auto

General Liability

Business Owners Policy

Personal Insurance

Classic Car Insurance

Our Company

Address : 2072 Orchard Drive, Suite A, Newport Beach, CA 92660
Email : [email protected]
Phone : 1-877-700-NEWS(6397)
Fax : (949) 791-1300

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BBB Accredited: Monday, January 11, 2021

BBB Rating as of: Monday, January 11, 2021