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Company Information
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Business
Name |
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Contact
Name
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Type of
Business |
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DBA |
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Your
Position |
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Business
Entity |
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Address |
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City
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Zip
Code |
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Cell
Phone |
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Work
Phone |
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Suite# |
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Home
Phone |
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Fax
Number |
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E-mail
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Vehicle Information
If over 7 Autos
Please Call |
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Year
Auto |
Make
of Vehicle |
Model
of Vehicle |
Vehicle
ID Number
(VIN
Helps in Rating) |
Driver
Use
(1-6) |
Garaging
Zip Code |
Special Equipment
(Rack / Tool box) |
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Auto 1 |
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Auto 2 |
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Auto 3 |
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Auto 4 |
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Auto 5 |
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Auto
6 |
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Auto
7 |
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Driver Information
If
over 6 Drivers Please Call
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Accidents |
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Full Name
of
Driver |
Drivers License
Number |
Date of Birth
MM/DD/YY |
Sex |
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Marital
Status |
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Tickets |
Non
Fault |
At
Fault |
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Driver 1 |
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Driver 2 |
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Driver 3 |
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Driver 4 |
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Driver 5 |
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Driver 6 |
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Please List any tickets or accidents in the last 4 years |
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Desired Coverage Limits
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Bodily
Injury |
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Uninsured
Motorist |
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Property
Damage |
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Medical
Payments |
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ENOC |
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Drive Other
Car Coverage |
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Deductible's |
Collision
Coverage |
Comprehensive
Coverage |
Rental
Coverage |
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Auto 1 |
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Auto 2 |
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Auto 3 |
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Auto 4 |
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Auto 5 |
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Auto 6 |
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Auto 7 |
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Auto Ins
Company |
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Policy
Expires
(Month
/ Date) |
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Business Ins
Company |
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Policy Expires
(Month
/ Date) |
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Would you like a General Liability
& Business Owners Quote Also? |
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How were you referred to our site? |
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Comments / Request |
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By
clicking the Submit button I have Reviewed the
Privacy Statement
and the
Auto Insurance Disclosure Statement
and
Understand that this is only
a quote for the State of California, any
information and does
not constitute a binder of
coverage or proof of Insurance in any form, or does it guarantee
insurance. All Coverage's are subject to the
terms and
conditions contained in the policy
and endorsements. I agree the above
information is true and factual. Insurance will not
begin until I sign a contract and make a down payment.
Please Read
Auto
Insurance Disclosure Statement below
This is not a binder or proof of Insurance.
Insurance & Notary Services
Business
Auto
Insurance Disclosure Statement
Please Read Below
Thank you for the opportunity to discuss your Business Auto insurance needs.
I look
Forward to
offering you the service and value that is
the standard of Ronn Hall Insurance. I am sure
you will see
hat this quote can affordable enhance your insurance program.
Please Note:
An Insured which refuses to Provide coverage to an applicant who is
a
“Good Driver” Must provide the applicant with a written
statement of the reasons it denied
coverage. In general, under
California law a “good driver” is a person who, during the last
three years, Has been continually licensed and has not had more than
one violation point or
more than One at-fault
accident resulting in only property damage.
As part of the
application process, Our Insurance Co. may collect personal information
from
Persons other than you or other individuals proposed for
coverage, including credit reports,
loss information reports,
CLUE,
and motor vehicle reports.
This information, as well as other personal
or privileged
information subsequently collected by us, may in certain circumstances be
disclosed to third parties without your authorization.
You have a right of access and correction
with respect
to al personal information we collect. If you would like more detailed
information
in writing about our information collection
practices, please let us know
All coverage’s are subject to the Terms and conditions
contained in the policy and
endorsements.
The Business Auto premiums shown are for a 12-month policy period.
If you have any questions please call me at the
Telephone number listed below.
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All material on this site is
intended for educational purposes only. Any proposals are not
contracts
or binders, No coverage will be afforded until an application is
completed, signed, underwritten, and
monies are exchanged. All Coverage's are subject to the terms and
conditions contained in the policy
and endorsements. If you have any questions Please call us @ (619)
660-8585
The publishers are not responsible or liable for misinformation,
misprints, or typographical errors.
All information provided is deemed reliable
but is not guaranteed and should be independently
verified. We are not responsible
for advertisers listed on this site, please research your data prior to
making a purchase.
Some links are
"Paid Ads" and will transfer you to various web sites, others are
links
including Virginia Hall Coldwell Banker, Santee Real
Estate , Mortgage companies, insurance
companies, Sporting sites, San Diego County,
government sites,
including School
Districts, and other web
sites.
All information provided is deemed reliable
but is not guaranteed and should be independently
verified. We are not responsible
for advertisers listed on this site, please research your data prior to
making a purchase.
06/20/2007 |
