Commercial Auto Quote
Oklahoma & Texas
Company Name
Name
*
Gender
*
Please Select
Male
Female
Assigned sex at birth for underwriter purposes.
Date of Birth
*
-
Month
-
Day
Year
Driver License
*
State
*
(SPOUSE OR SECOND DRIVER)
Name
Gender
Please Select
Male
Female
Assigned sex at birth for underwriter purposes.
Date of Birth
-
Month
-
Day
Year
Driver License
State
Enter Your Address
Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State / Province / Region
Zip Code
Previous Address (under 2 years)
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State / Province / Region
Zip Code
Occupation/Retired
*
COVERAGE SELECTION
Available Discounts
Any Accidents, Violations or Losses in the Past 5 Years?
*
Yes
No
What auto liability do you want?
*
50/100/50
100/300/100
250/500/250
100 CSL
300 CSL
500 CSL
1,000,000 CSL
Other
What comprehensive deductible do you have?
*
500
1000
None
Other
Uninsured Motorist Bodily Injury:
*
None
25/50
50/100
100/300
250/500
Other
What collision deductible do you have?
*
500
1000
None
Other
Provides coverage for injuries caused by an at fault driver that does not carry insurance. The policy must have Bodily Injury to add Uninsured Motorist Bodily Injury coverage.
Medical Payment
*
Please Select
$500 Per Person
$1,000 Per Person
$5,000 Per Person
$10,000 Per Person
None
Covers injury to individuals riding in the vehicle regardless of who caused the accident. The same coverage limits will apply to all vehicles on the policy. Bodily Injury coverage is required to select Medical Payments coverage.
Rental
*
Please Select
$40 Per Day ($1,200 Max)
$50 Per Day ($1,500 Max)
$60 Per Day ($1,800 Max)
None
Rental Reimbursement pays for rental car fees, up to the limit selected, if the customers' car is damaged and undriveable. This only applies to covered losses and not general maintenance. Please review the policy contract for complete coverage information. Rental Reimbursement can only be purchased on a car that has both comprehensive and collision.
Roadside
*
Please Select
Yes
No
Provides coverage if the insured's car is disabled due to a covered emergency and is available 24/7 in the United States and Canada. Towing Covered vehicle can be towed within a 15-mile radius, or to the nearest qualified repair facility. Winching Service Pulling a covered vehicle out of an area with a motor-powered cable or chain. Usually offered when a vehicle is trapped in mud, snow, water, or sand within 100 feet of road or highway. Battery Jump-Start Battery failure Fuel Delivery Fuel delivered directly to the covered vehicle. The insured is responsible for the cost of fuel. Locksmith Service Keys are lost, stolen or accidentally locked inside the covered vehicle, we will dispatch a qualified service provider. The insured is responsible for the cost to replace the keys. Flat Tire Change On Scene Labor Related to disablement, up to one hour. Trip interruption Provides daily maximums of $100 for lodging, $50 for alternative transportation, and $50 for food while the insured vehicle is being repaired, up to $500 per occurrence. The mechanical breakdown or accident must occur more than 100 miles from the insured's primary residence.
Snapshot Enrollment:* Monitoring Driving
*
Please Select
Yes
No
Less frequent driving or other good driving habits/behaviors may help your customers save with Snapshot.
General Liability: $1,000,000
*
Yes
No
Cargo
$100,000
$150,000
$200,000
Other
VEHICLES
1. VEHICLE Year, Make and Model
*
1. VEHICLE Vin Number
*
PLEASE TYPE CAPITAL LETTERS
LIEN HOLDER/ FINANCED
*
Yes
No
2. VEHICLE VIN Number
PLEASE TYPE CAPITAL LETTERS
2. VEHICLE
For an accurate quote we need your YEAR & VIN #
LIEN HOLDER/ FINANCED
Yes
No
3. VEHICLE
For an accurate quote we need your YEAR & VIN #
3. VEHICLE Vin Number
PLEASE TYPE CAPITAL LETTERS
LIEN HOLDER/ FINANCED
Yes
No
4. VEHICLE
For an accurate quote we need your YEAR & VIN #
4. VEHICLE Vin Number
PLEASE TYPE CAPITAL LETTERS
LIEN HOLDER/ FINANCED
Yes
No
FINALIZE & SUBMIT
USDOT#
When do you want your policy to start?
*
-
Month
-
Day
Year
Phone (We will not call you unless you have requested a call)
*
Please enter a valid phone number.
Format: (000) 000-0000.
Have you had 6 months of coverage?
*
Yes
No
Email
*
Confirmation Email
NOTES (ADD MORE VEHICLES HERE)
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How did you hear about us?
*
Please Select
Google
Google Maps
Yahoo
Internet Search
Referral
Ines Belman
John Shawareb
How would you like us to contact you?
*
Please Select
Call
Email
Text
TEXT (Opt-in text) (405) 369-4641
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*
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