COMMERCIAL AUTO

Please complete the survey to the best of your ability. We aim to cover all aspects comprehensively.

First Name *

Last Name *

Email *

Phone *

Address

City

State

What is your company's name? *

Can you share with us a good phone number to have on our records to text, or to call when, and if needed. *

What is your company's FEIN, or Tax ID? *

How many drivers are included in the policy? *

Can you provide the driver's license number of any driver included in the policy? *

Can you provide the date of birth of any driver included in the policy? *

Can you provide the full name of any driver included in the policy? *

How many vehicles are included in the policy? *

Can you provide the make and model for any vehicle included in the policy? *

a:- Make
b:- Model

Can you provide the V.I.N. and year for any vehicle included in the policy? *

1:- V.I.N#
2:- Year

What is your scope of work? *

What distance do your vehicles cover on their day to day operations? *

50 miles (Local)

Other:

What is the location where your vehicles are garaged? *

Is there a loan on any of the vehicles? *

Yes

Please let us know the name, and address of the lienholder (for all the vehicles that apply). *

a:- Name
b:- Address

Do any of your employees use any car that is not owned by your company to perform their duties on a day-to-day basis? *

Yes

What is each vehicle worth in today's market price? *

Tell us about your cars modifications

Car#1

1#Attached parts
1#cost/$

Car#2

2#Attached parts
2#cost/$

Car#3

3#Attached parts
3#cost/$

If more then put here all the details

Do you have any electronic device that records and transmits data on any vehicle?

Do you gather/keep MVR (Motor Vehicle Records) for your drivers? If so, for how long do you keep records?