Insurance Quote Form

Request a Quote

Fill the fields below accurately and we will return back to you in a short time
Name *

First Name Last Name
E-Mail
Email
Phone Number *

Area Code Phone Number
Fax Number

Area Code Phone Number
Company Name *
Company Name
Business Description *
Business Description: Tell us how long you have been in business and what you do.
E.I.N. *
Federal Tax I.D. Number
D.O.T Number (if applicable)
Department of Transportation Registration Number
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Type of Coverage Requested *
Please select coverage requested or contact us today!
How many drivers (operators)? *
Please be prepared to provide a schedule of your drivers, names, address, ss#, license number, birth date, D/L#. Make sure your policy covers ‘any vehicle’. When you are looking for your insurance it can be best to cover ‘any vehicle’ which will offer you the maximum protection. This is particularly important for larger fleets where vehicles will come and go throughout the life of the policy. Should you forget or accidentally miss updating your policy and a vehicle is involved in an accident, then your claim can be invalidated without this feature. Consider an ‘any driver’ policy. This type of policy, as opposed to a named policy, will allow each of your vehicles to be driven by any of your drivers (restrictions may apply). This will provide you with complete flexibility in managing your fleet.
Current Carrier Information: Company name, policy number, and if possible, your current broker's name. (Please fax or email us your current Declarations page and a Loss Run history for faster service). *
Current Insurance Policy Information (if currently insured)
Please supply a list of all vehicles requiring coverage: Year, Make, Model, V.I.N., Current Mileage, Description of what vehicle will be used for, average miles driven per day. (For faster service please fax or email us your current Declarations page and a Loss Run history).
Each company owned vehicle should be listed. (Required only if requesting vehicle coverages). We would be happy to visit you personally at your convenience! Contact us today!
Interested in "Bundling" your policies? *
A Commercial Package Policy or bundle, is designed to provide protection for just about any type of commercial risk out there. Under this policy, a business owner may combine different coverages and package them so that they cover the specific risks each business owner is exposed to. We'd be to meet you personally and review your needs and concerns.
Reasons Why We Should Be Your Broker: We believe in integrity, honesty and long-term business relationships. We pledge to give you honest, straightforward answers to your questions. Our staff makes the difference! People don’t do business with companies, they do business with people! We are family owned and live and work in the community just like you. We are not a faceless corporation or an online agency found on the internet. Our staff returns calls, emails and faxes promptly. It is inexcusable for anyone in the insurance business not to do so. We provide streamlined insurance services to enable you to manage your business quickly and efficiently. No wasted time, no BS. We will be there when you need us. We do not work for an insurance company; we work for you! As an independent insurance broker, our duty is to our clients best interests. As your broker, it is our responsibility to provide YOU the best service and the best coverage, at the best possible price. We know price is important to you – we bring value to your insurance program by marketing your quote or renewal with our network of national insurance providers. No one else comes close to our access to insurance markets! In the event that you find a lower rate from another company, we will review it and give you our fair opinion, even if it means that we will lose your business. We are here to answer your commercial insurance questions. Just call or e-mail us.
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Request a Quote