Automobile Insurance Quick Quote

Business Name: 

Mailing Address: 

Business telephone:   

Business fax:              

Website address:         

Contact Name:            

Contact Cell Phone:     

E-mail Address:          

With the exception of encumbrances (vehicle loans), are any vehicles
not solely owned by and registered to your company?   Yes No

Do over 50% of the employees use their autos in the business?   Yes No

Is there a vehicle maintenance program in operation?   Yes No

Are any vehicles leased to others?   Yes No

Are any vehicles customized, altered or have special equipment?   Yes No

Are ICC (Interstate Commerce Commission), PUC (Public Utility Commission) or other
filings required?   Yes No

Do any operations involve transporting hazardous material?   Yes No

Are any vehicles used by family members who are not employees or partners in the business? 
       Yes No

Does your company obtain driver record verifications?   Yes No

Are there any vehicles the company owns which you are not listing for insurance purposes?   Yes No

Do any of your drivers have moving traffic violations in the last three years?   Yes No

      Have any of your drivers had a DUI/DWI within the last five years?  Yes No

     Have any of your drivers ever had violations for reckless driving?   Yes No

Have the vehicles been inspected by a licensed mechanic recently?   Yes No

Coverage

Please use your current policies to tell us about the coverage you have now. If your current coverage is not adequate or is not what you need, you may tell us in the Remarks box at the end of the Coverage section.

Liability insurance:

covers other people's property if a fleet vehicle is in an accident

What kind of limits?

Combined single limit (includes bodily injury and property damage)    $100,000 $300,000 $500,000 $1,000,000    

Personal Injury Protection (Medical Coverage):

covers the medical costs of your drivers in case of accident

What kind of limits?

Medical Expense per accident      Deductible?  

Collision:

covers repairs to vehicles damaged in an accident

Deductible? 

After pushing the submit button you should see a confirmation screen showing the information you have sent to us. Please check it over and e-mail us with any corrections. We will call you to confirm the information and provide a quote for you.