Insurance Brokerage Service will be happy to quote your bus insurance coverage. Please answer each question that follows and then send the form to us over the net. Depending on the size your account and the nature of your business, the time to get an account quoted will vary. If you have a specific time constraint you are under to get the quote back, please let us know and we will do everything we can to accomadate you. This form is structured to allow you to enter up to 10 buses. Please note that in order to quote your insurance we will need some additional information FAXed to us. All of our carriers now require hard copy loss runs of your prior insurance experience, even if you've had no claims and regardless of the size of your account. Also, in addition to the driver's info required on this form all of our carriers also require current MVRs for all of your drivers. If you have 10 or more units you can either fill out the form below with the coverages you need, then FAX us your equipment list separately, or you can fill out the form with 10 vehicles, send it to us then repeat the process filling out only that part of the form on the vehicles and sending it until you have sent us all your units. Please remember that in order to quote your account we will have to have hard copy loss runs and current MVRs, which you can FAX to us. Our toll free FAX number is (800) 536-3802. Thanks for considering Insurance Brokerage Service.
This form is structured to allow you to enter up to 10 buses. Please note that in order to quote your insurance we will need some additional information FAXed to us. All of our carriers now require hard copy loss runs of your prior insurance experience, even if you've had no claims and regardless of the size of your account. Also, in addition to the driver's info required on this form all of our carriers also require current MVRs for all of your drivers.
If you have 10 or more units you can either fill out the form below with the coverages you need, then FAX us your equipment list separately, or you can fill out the form with 10 vehicles, send it to us then repeat the process filling out only that part of the form on the vehicles and sending it until you have sent us all your units.
Please remember that in order to quote your account we will have to have hard copy loss runs and current MVRs, which you can FAX to us. Our toll free FAX number is (800) 536-3802.
Thanks for considering
Please fill out the form completely. Partial information will only delay the quote process. Please note that we do not offer this coverage in all states. However, if you submit a risk from a state in which we do not write we will endeavor to refer you to an agent that does write in those states as we have contacts writing in most of the United States (coverage not available to risks located outside the United States).
Your Name:Comp Name: Address: City: State: Zip Code: Phone: FAX: E-Mail: County: Bus Use: AirportCharterChurchEntertainer/Athlete OwnedEntertainer/Athlete LeasedRegular Route
Do you presently have Insurance coverage for your vehicles? No Yes
With what insurance company are you with (we don't want to contact your present carrier)?
What is your normal radius of operations? Local (0-50 miles)Intermediate (51-200 miles)Unlimited (200+ miles)
What Liability Limits should we quote?$1,500,000$5,000,000
What Uninsured Motorist Limits should we quote? $60,000$100,000$300,000$500,000 $750,000$1,000,000$1,500,000$5,000,000
Marital Date Yrs Driver's Driver Status of Birth CDL Exp License # State
Seating Insured Year Make & Model Capacity Value Deductible
Please provide any information about claims incurred in the last 5 years. If you have had no claims please enter NONE in the area below. Remember, we must have hard copy loss runs and current MVRs for your drivers. Please let us know if you are FAXing those under separate cover. Our FAX number is (800) 536-3802. If you have any questions or would like to provide us with any other information, please enter it in the space below, then send the entire form to us by clicking on the SEND button.