Texas Commercial Auto form

Texas Commercial Auto Insurance

Texas Partners Insurance Group Commercial Auto Quote Page Texas Based Businesses, Commercial Auto Insurance.

We would like to provide you with a free, no-obligation commercial auto insurance quote. Please provide as much information possible for the most accurate quote. This information will be kept confidential and will be used for quote purposes only.

(Texas residents only, please.)

Please provide the following information:

Artisan Contractors Commercial Auto / Vehicle Quote Request Form

Please enter your commercial auto information:

Your Name:

Business Name:

Street Address:

City:

State:

Zip:

Email:

Phone:

Fax(optional):

Currently Insured?(If yes, list carrier, and # of years continuous. If no, type NONE):

Type of Business:(Please be specific, and tell how vehicles are used.):

DRIVER INFORMATION #1(if more than two drivers, list in remarks):

Name:

Birthdate:

Sex:

# Years U.S.Auto License:

NNumber & Type of Accidents within last 3 years:

Number & Type of MINOR violations within last 3 years:

Number & Type of MAJOR violations within last 3 years:

Daily commute in ONE WAY miles:

Does Driver need an SR22 FILING?:YesNo

Comments or Remarks?:

DRIVER INFORMATION #2 (if none, leave blank):

Name:

Birthdate:

Sex:

# Years U.S.Auto License:

NNumber & Type of Accidents within last 3 years:

Number & Type of MINOR violations within last 3 years:

Number & Type of MAJOR violations within last 3 years:

Daily commute in ONE WAY miles:

Does Driver need an SR22 FILING?:YesNo

Comments or Remarks?:

If More than 2 Drivers, List Driver Name, Age, and Driving Record in each box below:

Driver #3:

Driver #4:

Driver #5:

Driver #6:

Driver #7:

Driver #8:

COMMERCIAL VEHICLE #1:Should you have more than 5 vehicles, please call us at 866-TEXAS-45.Toll Free: 866-839-2745

Year of vehicle:

Make & Model:

Type (truck, tow-truck, bobtail, etc.):

Length in Feet:

Gross Vehicle Weight:

Cost New: $:

Radius of operation:

Value $:

List Special Equipment & Values(i.e., rack, tool box, etc.):

VEHICLE ID#(highly suggested for accurate rating:

COMMERCIAL VEHICLE #2:

Year of vehicle:

Make & Model:

Type (truck, tow-truck, bobtail, etc.):

Length in Feet:

Gross Vehicle Weight:

Cost New: $:

Radius of operation:

Value $:

List Special Equipment & Values(i.e., rack, tool box, etc.):

VEHICLE ID#(highly suggested for accurate rating:

COMMERCIAL VEHICLE #3:

Year of vehicle:

Make & Model:

Type (truck, tow-truck, bobtail, etc.):

Length in Feet:

Gross Vehicle Weight:

Cost New: $:

Radius of operation:

Value $:

List Special Equipment & Values(i.e., rack, tool box, etc.):

VEHICLE ID#(highly suggested for accurate rating:

COMMERCIAL VEHICLE #4:

Year of vehicle:

Make & Model:

Type (truck, tow-truck, bobtail, etc.):

Length in Feet:

Gross Vehicle Weight:

Cost New: $:

Radius of operation:

Value $:

List Special Equipment & Values(i.e., rack, tool box, etc.):

VEHICLE ID#(highly suggested for accurate rating:

COMMERCIAL VEHICLE #5:

Year of vehicle:

Make & Model:

Type (truck, tow-truck, bobtail, etc.):

Length in Feet:

Gross Vehicle Weight:

Cost New: $:

Radius of operation:

Value $:

List Special Equipment & Values(i.e., rack, tool box, etc.):

VEHICLE ID#(highly suggested for accurate rating:

Comments

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Texas Commercial Auto form

Texas Commercial Auto Insurance

(Texas residents only, please.)

Please enter your commercial auto information:

DRIVER INFORMATION #1(if more than two drivers, list in remarks):

DRIVER INFORMATION #2 (if none, leave blank):

If More than 2 Drivers, List Driver Name, Age, and Driving Record in each box below:

COMMERCIAL VEHICLE #1:Should you have more than 5 vehicles, please call us at 866-TEXAS-45.Toll Free: 866-839-2745

VEHICLE #1 COVERAGES:

COMMERCIAL VEHICLE #2:

VEHICLE #2 COVERAGES(Limits of Liability Will Be Same as Vehicle #1):

COMMERCIAL VEHICLE #3:

VEHICLE #3 COVERAGES:(Limits of Liability Will Be Same as Vehicle #1):

COMMERCIAL VEHICLE #4:

VEHICLE #4 COVERAGES:(Limits of Liability Will Be Same as Vehicle #1)

COMMERCIAL VEHICLE #5:

VEHICLE #5 COVERAGES:(Limits of Liability Will Be Same as Vehicle #1)

Comments