Limousine Quick Quote Form

Company Name:
Contact:
E-mail Address:
Street Address:
City, State, Zip Code:
Telephone Number:

Garaging Location Street: City: State:
Description of Operations (ex. Airport and Corporate Limousine Work):
Territory of Operations/Most Frequent Destinations

Vehicle Schedule/Coverages
Vehicle #1 (Please include Year, Make, Model & Seating Capacity):	Vehicle #2 (Please include Year, Make, Model & Seating Capacity):
Vehicle #1 Coverages:	Vehicle # 2 Coverages:

Vehicle #3 (Please include Year, Make, Model & Seating Capacity):	Vehicle #4 (Please include Year, Make, Model & Seating Capacity):
Vehicle #3 Coverages:	Vehicle #4 Coverages:

Coverage Features
Liability Limit (Bodily Injury/Property Damage):
Personal Injury Protection (PIP):
Physical Damage Coverage (Comprehensive & Collision):

General Underwriting Questions
1) Are you a New Venture?
2) Are you currently insured?
3) Do All Drivers have a Class E License?

Additional Information (Please include any additional Vehicles, Drivers, Coverages, Loss Information, etc.):
We will provide you with a preliminary quotation using the above information. One of our Customer Service Representatives will contact you fordrivers license numbers and any other pertinent information required to provide you with a firm quotation.