Customer Submission
Thank you for your interesting being appointed with ABI. Please provide a customer submission along with your appointment request for quoting.
Broker Name
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Customer Contact Information
Please provide the customers contact information
Customer Name
*
First Name
Last Name
Are the customer's vehicles registered under an LLC, Corporation, or Partnership?
*
Yes
No
What is the company's name?
*
Customer Garaging Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Customer Vehicle Information
Please provide each vehicle owned by the customer.
Vehicles
*
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Additional Insureds
Please provide any additional insureds, including lienholders.
Additional Insureds
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Customer Driver Information
Drivers
*
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Underwriting Questions
Years In Business
*
Please enter the number of years in business. '0' can be used for new ventures.
Auto Liability Limit
Please provide split limits like this (100/300/100).
Does the insured have a TCP Number?
*
Yes
No
Please enter their TCP Number
Upload MVRS
*
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Upload Loss Runs
*
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