Tow Quote - Detailed

Owner Name:

Owner Date of Birth:

Owner Driver's License number and state:

Contact Person and title:

Contact phone:

Contact email:

Company Name:

DBA If Applicable:

Office Phone #:

Email Address:

TDLR/Certificate #/VSF #:

Renewal Date:

How many drivers?

FEIN/SSN (EIN for the company):

Mailing Address:

Physical Address:

Do you do any repo towing?

Do you require Wrongful Repo/Drive-away Coverage?

What limits are required? 300K, 500K, or 1 million?

Do you have a US DOT or MCDOT #? If yes, please list below:

What type of towing do you perform? Consent/Incident Management/Private Property

Do you have a telematic system? (Yes or No) If Yes, provide the name of the platform.

Current Premium (carriers WILL ask for this now):

What combined single limit (CSL) do you require? 300,000/500,000/1,000,000

What on hook/cargo limit do you need? 25,000/50,000/100,000/200,000

Do you want UM coverage?

Do you want PIP coverage?

What are your gross sales per year?

What is your payroll per year?

Do you own a body shop, storage lot, mechanic shop, or used car lot?

If yes, are you wanting a package or just the tow trucks?

How many years in business?

**Do you have a copy of your loss runs? If not, please provide the policy # and carrier name and we can order those for you. We need the last 5 years to submit a quote.

List of ALL Drivers:

	Driver	Driver	Driver	Driver	Driver	Driver
Full Name:
DOB:
DL #:
Date of Hire:
Years of Experience:

List of ALL Drivers:

	Driver	Driver	Driver	Driver	Driver	Driver
Full Name:
DOB:
DL #:
Date of Hire:
Years of Experience:

List of ALL Units (Carriers now cross-reference with TDLR):

	Tow Truck	Tow Truck	Tow Truck	Tow Truck	Tow Truck	Tow Truck
Year/Make/Model
VIN:
VALUE:
Body Type (flatbed/rollback, wrecker etc.):

Continued list of Units:

	Tow Truck	Tow Truck	Tow Truck	Tow Truck	Tow Truck	Tow Truck
Year/Make/Model
VIN:
VALUE:

If ANY losses will show on your last 5 years of loss run reports, please include details for each loss (Carriers now ask for this information):

Other Notes:

Who filled out this form?

Tow Quote- Detailed