Mike Bonner, Insurance Broker's "Quick Auto Insurance Quote Schedule"  For up to eight power units.  Copyright 2007 Mike Bonner. All rights reserved

NOTE:  AFTER FILLING IN YOU INFORMATION, YOU CAN PRINT THE PAGE & THEN EMAIL IT OR FAX IT AS AN OPTION.

Name

 

Street Address

 
City

 
State

 
Zip

  

Email

 


Phone

 

  Garaging City & Zip Code . 

 *Garaging City & Zip Code means where the rig is parked when not in use;  the key as to how the companies generate their rates; leave it blank if it is the same as your mailing address.

In addition to Commercial Auto Insurance, we also handle all types of Inland Marine

Floaters,  Contractor's Equipment, and Logger's Equipment Including Loggers P.D.

 This Rig can make you money or cost you money

 We do not Use the Assigned Risk (CAARP).

 (Because our certificates must go out within 24 hours.)

 

  Radius    Cargo limit (000)      Cargo Hauled   Yrs in Business     CA #   

DOT/MC  Number            Insurance Company/Policy#   (optional )    Losses from Trucking Operation only   

 Amount. $         Liability Limits Required $      Deductible for Comp/Collision

SCHEDULE OF VEHICLES.  FILL IN ONLY WHAT YOU NEED.

  POWER UNITS:

  1.  Yr Make GVW ID#  (VIN)  Comp/Coll  Value Radius

  2.  Yr Make GVW ID#  (VIN)  Comp/Coll  Value Radius

  3.  Yr Make GVW ID#  (VIN)  Comp/Coll  Value Radius

  4.  Yr Make GVW ID#  (VIN)  Comp/Coll  Value Radius

  5.  Yr Make GVW ID#  (VIN)  Comp/Coll  Value Radius

  6.  Yr Make GVW ID#  (VIN)  Comp/Coll  Value Radius

  7.  Yr Make GVW ID#  (VIN)  Comp/Coll  Value Radius

  8.  Yr Make GVW ID#  (VIN)  Comp/Coll  Value Radius

 TRAILERS:

  1. Yr Make VIN- (Optional) Comp/Coll    Value    

  2. Yr Make VIN- (Optional) Comp/Coll    Value    

  3. Yr Make VIN- (Optional) Comp/Coll    Value    

  4. Yr Make VIN- (Optional) Comp/Coll    Value    

  5. Yr Make VIN- (Optional) Comp/Coll    Value    

  6. Yr Make VIN- (Optional) Comp/Coll    Value    

  7. Yr Make VIN- (Optional) Comp/Coll    Value    

  8. Yr Make VIN- (Optional) Comp/Coll    Value    

  9. Yr Make VIN- (Optional) Comp/Coll    Value    

  10. Yr Make VIN- (Optional) Comp/Coll    Value    

DRIVERS:

  1.      Last Name  DOB (mm/dd/yy)    License # DMV Points (optional) 

  2.      Last Name  DOB (mm/dd/yy)    License # DMV Points (optional) 

  3.      Last Name  DOB (mm/dd/yy)    License # DMV Points (optional) 

  4.      Last Name  DOB (mm/dd/yy)    License # DMV Points (optional) 

  5.      Last Name  DOB (mm/dd/yy)    License # DMV Points (optional) 

  6.      Last Name  DOB (mm/dd/yy)    License # DMV Points (optional) 

  7.      Last Name  DOB (mm/dd/yy)    License # DMV Points (optional) 

  8.      Last Name  DOB (mm/dd/yy)    License # DMV Points (optional) 

  9.      Last Name  DOB (mm/dd/yy)    License # DMV Points (optional) 

  Unidentified; (Non-Owned Trailers) that need Comprehensive and Collision?  Number    Value on each $(000)      

  Comprehensive & Collision deductible $ (Applies to Unidentified Trailers)

  If you are looking for Truck Insurance only; you may go to the "Submit Form" button now.

                           If you are looking for a General Liability and or Property Quote go here:   General Liability is needed

  You can Also 'Save' This page; 'Print' it and then email or fax it to bonnermike@att.net

Or- my phone/fax number (209) 852-9085.  That way you can keep a copy of your work!  A damn good idea in these days of interrupted communications.

       And ... If you have more than 8 Rigs>>   Extra Schedule                               

Home  

You can use this box if you prefer to send The Vehicle Schedule from your computer>>   

Copyright 2007 Mike Bonner. All rights reserved

Don't forget the  optional Information & Links  

Hit Counter