Tow Truck Quote Sheet

Tow Truck Quote Name_________________________________________________ Name of company____________________________________ Mailing Address________________________________________ City _________________ State ________ Zip________________ Garaging Address If different______________________________ Phone # _____________________ Phone # ________________ List of Drivers Name M or S Age Drivers License # __________________________________________________________________________________________________________________________________________________________________________________________________________________ List of Vehicles Year Make Flatbed or Wrecker Vin # $ Value if full ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Coverage 500,000 CSL Liability or 750,000 CSL Liability 500,000 CSL Garage 750,000 CSL Garage 25,000 Car On Hook 50,000 Car on Hook 20,000/40,000 UM 20,000/40,000 UM Full coverage (Physical Damage $1,000) Relocating ICC Filing Yes or No Yes or No Yes or No Do they have prior insurance? ______ If so With what company? ________________________ Do you have Current Insurance __________ Any losses? _______________________________ Notes_______________________________________________________________________________________________________________________________________________________________________ Total = $ _________ / year Down Payment = $ __________

Home Owners Application

Home Owners Quote / Renters Quote

First  Name * _________________     Last Name _____________________

Address of Residence * _____________________________________

City ___________________________         State          Zip Code

Phone * __________________________ Email________________________________

Date Of Birth____________        Employment Info_________________________

·         Type of Residence *

                  Circle One

O Single Family Home       Condo                      O     Own        Rent

             

               Construction Type

                    Circle One                       O Brick          Frame

·         Check All That Apply

Owner Occupied Alarm Currently Insured

   

Approximate year the home was built. ___________________________

Value of Residence *

      Value of Contents *         Cost to replace content

Approximate Square Footage   # of Floors?___________

Distance to Fire Hydrant __________ Distance to Fire Station_____________

Currently Insured? ___________ If so where__________________________

When was Electrical updated? ____________ Owner Occupied? __________

Muti-Family? __________ Are any units Rented?_______________________

·         Questions or Comments

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