Advanced Insurance Solutions Woodinville, King County, Washington State

Business Auto Quote

Form: Commercial Auto Insurance Quote

Commercial Auto Insurance Quote

Contact Information

Current Insurance Information

Insurance Company Name: (NOT* Insurance Agency/Broker)*
Policy Exp. Date:		Premium Amt:
Term:		How long w/current?

Vehicle Information - (More than 4 Vehicles?
Check here)

(List all cars owned or leased)
Vehicle 1:	Year	Make/Model	Vin #

	Yearly Mileage	Usage	Alarm


Vehicle 2:	Year	Make/Model	Vin #

	Yearly Mileage	Usage	Alarm


Vehicle 3:	Year	Make/Model	Vin #

	Yearly Mileage	Usage	Alarm


Vehicle 4:	Year	Make/Model	Vin #

	Yearly Mileage	Usage	Alarm

Any Custom equipment on vehicles? (if YES, give their value & indicate which vehicle(s):
Debris hauled for others?:
Trailer Hitch?:
Class of Business:

Coverage Information

Liability limits for bodily injury & property damage:
Uninsured Motorist Bodily Injury:

Deductibles

Driver Information - (More than 4 Drivers?
Check here)

Accidents / Violations in the last 5 years?


	Driver 1	Driver 2	Driver 3	Driver 4
Minor violations - speeding, turn, stop sign, red light, etc.
Accidents - non chargeable
Accidents - chargeable
Chargeable Accident Cost($):
Major violations - drunk driving, reckless, hit and run, etc.

Any additional comments or information
that might be helpful in your quote

No coverage of any kind is bound or implied by submitting information via this online form

Information from you and other sources, such as your driving, claims and insurance histories, may be used to calculate an accurate price for your insurance.
We will not distribute information to other parties other than for insurance underwriting purposes.
By submitting this form, you agree to release us from any liability should this information be accidentally viewed by others.

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