TRUCK INSURANCE

Insurance Brokerage Service will be happy to quote your commercial auto/truck insurance. Please answer each question that follows and then send the form to us over the net. Typically we will have your quote back within 72-hours. Depending on the size of your account and the nature of your business, the time to get an account quoted will vary. For smaller accounts (fewer than 5 units) we can usually get you a number of quotes within 24-hours. 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 accomodate you.

This form is structured to allow you to enter up to 10 commercial vehicles. If your account has 5 or more units please note that virtually all of our carriers will want to see hard copy loss runs of your prior experience, even if you've had no claims. 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, though, that for 5 or more units we will have to have hard copy loss runs, which you can FAX to us. Thanks for considering Insurance Brokerage Service.

Note: Items with an asterick (*) beside them indicate a question that must be answered to receive a quote.

 Your Name:Comp Name: 
  Address:  
      City:      State:       Zip Code: 
     Phone:  FAX:  E-Mail: 
    County:Type Business:

                Marital   Date           Yrs   Driver's
Driver          Status    of Birth CDL   Exp   License #  State

                     Insured             
Year   Make & Model  Type            GVW        Value    Deductible  VIN