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Thank you for your interest in quoting with Freedom Quest. In order to complete your quote we will need the following information:

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General Information

Commercial Auto Insurance Quote Form :

Company Name Start date
Operating as:
DOT MC Radius
Type of Authority:

Ownership

Company Owner

Name: DOB Years in business
Phone # Email
Address City/State/Zip

Coverages

Current ins Premium $ Claims:
Exp date Term: Desired effective date:
Garaging address:
Primary Liability/UM Limits requesting $ Cargo? $
Physical damage Deductibles Coll:$ Comp: $ Full PIP
Nature of operation:
Hauling:
Ok to request copy of Loss Runs:
ELD Smart Haul Program:
Contractors hauled for:

Vehicle Information

Vehicle(s) Information

VIN Make Model Yr Value Type of Vehicle
VIN Make Model Yr Value Type of Vehicle
VIN Make Model Yr Value Type of Vehicle
VIN Make Model Yr Value Type of Vehicle
VIN Make Model Yr Value Type of Vehicle

Driver(s)

Name DOB C/DL Yr DL State Date of Hire years of driving
Name DOB C/DL Yr DL State Date of Hire years of driving
Name DOB C/DL Yr DL State Date of Hire years of driving
Name DOB C/DL Yr DL State Date of Hire years of driving
Name DOB C/DL Yr DL State Date of Hire years of driving

Other

Is all equipment operated under the same authority?
Do you sub-haul, lease or hire equipment from others?
Do you lease to others?

If towing business:

What percentage (%) of your business involves repossession work?
Is your business on-call 24/7?
Do you garage/impound towed vehicles?
Garaging Location:
Does your towing business have contracts with any organization? (AAA, Roadside Service, etc.)

Other Coverage Desired?

Annual Revenue$ Payroll $

Submission Checklist:

Submission Form MVRs Loss Runs IFTAs BOR

Notes