Dallas Commercial Auto Insurance Quote

Contact Information

First & Last Name ✶

Title ✶

Email ✶

Phone ✶

Driver Information

Full Name (As Appears on the Driver License ✶

Owners Home Address ✶

DOB ✶

Driver License Issued State ✶

Driver License Number ✶

Date of Loss

Type of Loss

At Fault

Yes No

Auto Claim Payment Amount

Vehicle Information

VIN ✶

Zip Code where the vehicle is located ✶

Farthest one-way distance this vehicle typically travels (90% or more of the time) ✶

Estimated Annual Milage ✶

Is this vehicle used for business, personal or both? ✶

Is there a loan/lease on this vehicle? ✶

Yes No

Loan/lease company name

Loan/ lease company address

Loan/lease number

Does the customer need Comprehensive or Collision coverage to protect this vehicle in an accident or loss? ✶

Yes No

Comprehensive Deductible

Collision Deductible

What is the total value of all permanently attached equipment (including aftermarket parts, mounted equipment, and modifications)?

Do you work within Texas Only?

Yes No

Which states do you move freight to?

Customer's Business Information

Currently insured? ✶

Yes No

Personal Auto policies also qualify as proof of prior insurance - except for For-Hire Livery

Do you currently have other coverages for the business? ✶

Date Business Started ✶

Does the company have a MC #

Yes No

Enter the MC #

Does the company have a DOT #

Yes No

Enter the DOT #

Auto Claim / Loss History

Have there been any Auto related claims or violations in the last 5 years? ✶

Yes No

Date of Claim or Violation

Description

Amount Paid

Coverages Applied To All Vehicles

Bodily Injury and Property Damage Liability ✶

Uninsured/Underinsured Motorist Bodily Injury ✶

Uninsured Motorist Property Damage ✶

$25k with a $250 Deductible

Only available if uninsured/underinsured motorist Bodily Injury is selected

Personal Injury Protection ✶

Cargo Coverage ✶

Yes No

Types of Cargo Hauled

Limit

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Commercial Auto Insurance

Vanguard Insurance Group

Insurance Quote Request

Contact Information

Driver Information

Vehicle Information

Customer's Business Information

Auto Claim / Loss History

Coverages Applied To All Vehicles

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