Commercial Auto Quote

Driver 1
Name: First Name   Last Name   
Date of Birth:   Date   License Number :      
Home Address:    Street Address   Address Line 2   City   Province   Postal Code 

License Dates
G1:   Date   G2:   Date   G:   Date   

Married?   Yes   No   
Driver's Training Completion Date:    Date   
Date continuously insured without interruption:    Date   
Years of experience in this type of operation:     



Driver 2
Name: First Name   Last Name   
Date of Birth:   Date   License Number :      
Home Address:    Street Address   Address Line 2   City   Province   Postal Code 

License Dates
G1:   Date   G2:   Date   G:   Date   

Married?   Yes   No   
Driver's Training Completion Date:    Date   
Date continuously insured without interruption:    Date   
Years of experience in this type of operation:          



Driver 3
Name: First Name   Last Name   
Date of Birth:   Date   License Number :      
Home Address:    Street Address   Address Line 2   City   Province   Postal Code 

License Dates
G1:   Date   G2:   Date   G:   Date   

Married?   Yes   No   
Driver's Training Completion Date:    Date   
Date continuously insured without interruption:    Date   
Years of experience in this type of operation:     



Driver 4
Name: First Name   Last Name   
Date of Birth:   Date   License Number :      
Home Address:    Street Address   Address Line 2   City   Province   Postal Code 

License Dates
G1:   Date   G2:   Date   G:   Date   

Married?   Yes   No   
Driver's Training Completion Date:    Date   
Date continuously insured without interruption:    Date   
Years of experience in this type of operation:                    

Vehicle 1
Year:    Date   Make:       
Model:       
Vin:       Purchase Date:    Date   
New   Used   Demo   
Use – km one way:         
Annual km:       


Vehicle 2
Year:    Date   Make:       
Model:       
Vin:       Purchase Date:    Date   
New   Used   Demo   
Use – km one way:          
Annual km:       


Vehicle 3
Year:    Date   Make:       
Model:       
Vin:       Purchase Date:    Date   
New   Used   Demo   
Use – km one way:          
Annual km:       


Vehicle 4
Year:    Date   Make:       
Model:       
Vin:       Purchase Date:    Date   
New   Used   Demo   
Use – km one way:          
Annual km:       

Vehicle 1
Financed   Leased   Own      

If Financed or Leased
Name of Company:      
Address:    Street Address   Address Line 2   City   Province   Postal Code   


Vehicle 2
Financed   Leased   Own      

If Financed or Leased
Name of Company:      
Address:    Street Address   Address Line 2   City   Province   Postal Code   


Vehicle 3
Financed   Leased   Own      

If Financed or Leased
Name of Company:      
Address:    Street Address   Address Line 2   City   Province   Postal Code   


Vehicle 4
Financed   Leased   Own      

If Financed or Leased
Name of Company:      
Address:    Street Address   Address Line 2   City   Province   Postal Code   

Vehicle 1
Primary Driver:    First Name   Last Name
Secondary Driver:    First Name   Last Name   
Registered Owner:    First Name   Last Name


Vehicle 2
Primary Driver:    First Name   Last Name
Secondary Driver:    First Name   Last Name   
Registered Owner:    First Name   Last Name


Vehicle 3
Primary Driver:    First Name   Last Name
Secondary Driver:    First Name   Last Name   
Registered Owner:    First Name   Last Name


Vehicle 4
Primary Driver:    First Name   Last Name
Secondary Driver:    First Name   Last Name   
Registered Owner:    First Name   Last Name

Winter Tires
Vehicle 1:  Yes   No
Purchase Date:Date   

Vehicle 2: Yes   No   
Purchase Date:Date   

Vehicle 3: Yes   No  
Purchase Date:Date   

Vehicle 4: Yes   No   
Purchase Date:Date   

Percentage % of Pleasure Use
Vehicle 1:    
Vehicle 2:    
Vehicle 3:    
Vehicle 4:    

Average number of customer locations visited per day
Vehicle 1:      
Vehicle 2:       
Vehicle 3:      
Vehicle 4:       

Normal operating distance - one way
Vehicle 1:    
Vehicle 2:    
Vehicle 3:    
Vehicle 4:    

Percentage % of total trips in this radius
Vehicle 1:    
Vehicle 2:    
Vehicle 3:    
Vehicle 4:    

Maximum operating distance - one way
Vehicle 1:     
Vehicle 2:       
Vehicle 3:    
Vehicle 4:        

Number of trips per month beyond normal radius
Vehicle 1:     
Vehicle 2:       
Vehicle 3:    
Vehicle 4:       

Most Common Destinations
Vehicle 1:         
Vehicle 2:        
Vehicle 3:       
Vehicle 4:    


Any machinery and/or equipment mounted on or attached
Yes   No   

Any vehicle used to tow a trailer  
Yes   No   

Carry explosives, nuclear/radioactive or dangerous goods  
Yes   No   

Vehicle used for delivery  
 Yes   No   

Hauling done for others
Yes   No      

Used for carpooling
Yes   No   

Used for ride sharing (Uber, Lyft, etc.) 
Yes   No   

Any vehicle used for public transportation  
Yes   No   

Any unrepaired damage 
Yes   No   

Any modifications or customizations from factory built 
Yes   No   

Rented or leased to others 
Yes   No   

Any special/seasonal use (example: snow removal, road salting)
Yes   No      

Vehicle 1
Name of Company:      
Policy Number:      
Expiry Date:   Date   

Length of time with driver:      


Vehicle 2
Name of Company:      
Policy Number:      
Expiry Date:   Date   

Length of time with driver:    


Vehicle 3
Name of Company:      
Policy Number:      
Expiry Date:   Date   

Length of time with driver:    


Vehicle 4
Name of Company:      
Policy Number:      
Expiry Date:   Date   

Length of time with driver:    

Liability

$1million, $2million or higher if offered
Vehicle 1:   Type a label   
Vehicle 2:   Type a label   
Vehicle 3:   Type a label  
Vehicle 4:   Type a label   


Collision Deductible $500, $1000 or higher
Vehicle 1:   Type a label   
Vehicle 2:   Type a label   
Vehicle 3:   Type a label  
Vehicle 4:   Type a label   


Comprehensive Deductible $500, $1000 or higher
Vehicle 1:   Type a label   
Vehicle 2:   Type a label   
Vehicle 3:   Type a label  
Vehicle 4:   Type a label   

Rental Car Coverage
Vehicle 1: Yes   No   
Vehicle 2: Yes   No      
Vehicle 3: Yes   No   
Vehicle 4: Yes   No       

Accident Forgiveness Protection
Vehicle 1: Yes   No   
Vehicle 2: Yes   No      
Vehicle 3: Yes   No   
Vehicle 4: Yes   No       

Conviction Protection
Driver 1: Yes   No   
Driver 2: Yes   No      
Driver 3: Yes   No   
Driver 4: Yes   No       

Increased accident benefits from the included standard
Vehicle 1: Yes   No   
Vehicle 2: Yes   No     
Vehicle 3: Yes   No      
Vehicle 4: Yes   No      

Permission to pull all necessary reports for all drivers
Driver 1: Yes   No   
Driver 2: Yes   No 
Driver 3: Yes   No 
Driver 4: Yes   No