POLICY RECOMMENDATIONS(Please check any you are interested in)
Hired & Non-Owned Auto
Section 1: Submission Requirements
Please Note: We must receive the documents below before a quote is issued. Thank you for your cooperation.
1) Copy of waiver
2) Copy of safety rules
3) Copy of written emergency & training procedures
4) Business Plan (New Businesses Only)
5) Resume (New Business Only)
6) Currently dated loss runs
7) Faciility Diagram
8) Pictures of rooms
Section 1: COMPANY INFORMATION
How did you hear about us?
1. Corporate Name:
2. Does the applicant operate any other operations at this location?
Description of business:
Does the applicant have seperate insurance for this operation?
3. Is named insured an:
4. Years in this business:
5. Number of Employees. Full Time:
Annual Payroll: $
Fixed site only - provide complete address
Mobile - list ALL states where operation anticipated:
Create Password (this will allow you to access you application at a later time) :
Please make sure that you have completed everything to the best of your knowledge before going to the next page.