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?

Do you need Worker's Comp coverage?

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?*

Is Garage Coverage needed?*

Is Commercial General Liability needed?*

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? We will need an UPDATED COPY for the last 5 years to submit a quote. They need to be dated within 60 days of your renewal date.*

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.):
Light/Med/Heavy

Continued list of Units:

	Tow Truck	Tow Truck	Tow Truck	Tow Truck	Tow Truck	Tow Truck
Year/Make/Model
VIN:
VALUE:
Body Type:
Light/med/heavy

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