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Commercial Auto Information Form
Legal Company Name (As filed with the state)
DBA Company Name
Company Type
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C-Corporation
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Contact Name
Company Phone Number
Contact Mobile Phone Number
Company Address
Company Website
Company FEIN or Tax ID
NAICS or SIC Code
Year Business Founded
Requested Effective Date of Policy(s)
How Many Owners In The Business?
How Many Autos? (If more than 3 please email us at sales@wordpress-816312-3363583.cloudwaysapps.com) (Please include Vehicle Info, Year, Make, Model, VIN, GVW (if applicable), Radius of Operation, Garaging Address) (Does The Vehicle Require Comprehensive And Collision) (Does the vehicle have additional equipment installed, If yes, describe the different pieces of equipment and their value)
How Many Drivers? (If more than 3 email us at sales@wordpress-816312-3363583.cloudwaysapps.com, include current driver schedule, name, address, DOB, DL#, state, date of employment)
Any Lienholders On The Vehicles? (If yes please provide policy info)
Any Previous Losses? (If yes please list or email us at sales@wordpress-816312-3363583.cloudwaysapps.com with operator, description, date, and estimated loss.)
Any Previous Accidents/Violations? (If yes then list or email us at sales@wordpress-816312-3363583.cloudwaysapps.com with history including operator, description, date, and estimated loss.)
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