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Atlantic Insurance Services will give you what you pay for...insurance knowledge, insurance expertise and prompt service. Above all, we get paid to provide results - not excuses.
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Commercial Auto Insurance Quote
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General Information
Contact Name *
eMail *
Business Name
Address
City
State
Zip
County
Business Phone
Fax
Cell/Mobile Phone
Current Insurance Company
(not agency)
Company Name
Policy Expiration Date
Annual Premium
Have you been canceled in the past 3 years?
Yes
No
Have you been non-renewed in the past 3 years
Yes
No
Coverages
Limit of Liability
$300,000
$500,000
$1,000,000
Comprehensive Deductible
$500
$1,000
Collision Deductible
$500
$1,000
Driver Information
Driver's Full Name
Driver's License Number
License State
Date of Birth
Gender
Male
Femail
Marital Status
Married
Divorced
Single
Tickets or Accidents?
Yes
No
Other Drivers to be Listed?
Yes
No
Vehicle 1 Information
Year *
Make *
Model *
VIN#
Gross Vehicle Weight
Where do you park at night?
Driver of Vehicle
Vehicle 2 Information
Year
Make
Model
VIN#
Gross Vehicle Weight
Where do you park at night?
Driver of Vehicle
* indicates required fields
Disclaimer Notice
- The premiums quoted are estimates based on information you provided. This quotation does not constitute a contract of insurance, nor does it provide coverage for any loss or claim. Coverage can only be bound by an agent with a signed application and a down payment.
© 2007 Atlantic Insurance Services. All rights reserved.