Commercial Automobile Questionnaire
_________________________________________

Business Name:

Select One: Sole Proprietor Corporation ('S') Corporation ('C') Corporation (LLC) Partnership

 

Contact Person:

Address - Street:

Address - Mailing:

City: State: Zip:

Phone: Fax: Email:

Please contact us by: Phone Fax Email

 

Type of Business:

Number of Vehicles in Fleet:

 

Please describe your business -

 

Size of Fleet: Current Carrier:

Exp. Date: Gross Sales:

Have more than one location:

 

Schedule of Vehicles -

Vehicle 1

Year:
Make:
Model:
Radius of Operation:
Cost New:
GVW (Trucks Only):

Vehicle 2

Year:
Make:
Model:
Radius of Operation:
Cost New:
GVW (Trucks Only):

Vehicle 3

Year:
Make:
Model:
Radius of Operation:
Cost New:
GVW (Trucks Only):

Vehicle 4

Year:
Make:
Model:
Radius of Operation:
Cost New:
GVW (Trucks Only):

Vehicle 5

Year:
Make:
Model:
Radius of Operation:
Cost New:
GVW (Trucks Only):

Vehicle 6

Year:
Make:
Model:
Radius of Operation:
Cost New:
GVW (Trucks Only):

Vehicle 7

Year:
Make:
Model:
Radius of Operation:
Cost New:
GVW (Trucks Only):

Vehicle 8

Year:
Make:
Model:
Radius of Operation:
Cost New:
GVW (Trucks Only):

Vehicle 9

Year:
Make:
Model:
Radius of Operation:
Cost New:
GVW (Trucks Only):

Vehicle 10

Year:
Make:
Model:
Radius of Operation:
Cost New:
GVW (Trucks Only):

 

_________________________________________