Tow Truck Insurance Application

Step 1 of 14

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• Your Business

• Policyholder Information

• Business Name*
• TypeIndividualPartnershipCorporationLLC
• DBA
• Garaging / Location Address*
  
  Street Address
  
  Address Line 2
  
  City
  AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific
  State
  
  ZIP Code
  
• Is the garaging address the same as the mailing address?*
  • Yes
  • No
• Mailing Address
  
  Street Address
  
  Address Line 2
  
  City
  AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific
  State
  
  ZIP Code
  
• Your Name*
  
  First
  
  Last
• Phone NumberBest number to reach you to discuss your quote.
• Email*
  
  Quote will be emailed to the email address provided.

• Your Business

• Does Your Business Require State Filings?*
  • Yes
  • No
• Business Operations*
  • 
    Select All
  • 
    Towing
  • 
    Storage
  • 
    Repair

  Choose your business operations

• Years in Business*New Business1 – 34 – 77 +
• Do You Have Prior Insurance?*
  • Yes
  • No
• Insurance Company
• Expiration DateMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920
• Number of Vehicles12345+
• Number of Drivers*12345678910+

• Coverage

• Tow Truck Insurance Coverage

  Physical damage coverage options will be shown on vehicles tab.

• Liability Limits Desired*$500,000 CSL$750,000 CSL1,000,000 CSLBodily Injury and Property Damage
• On Hook Coverage*None$25,000$50,000$100,000$200,000
• On Hook Deductible$250$500$750$1,000

• Repair Shop & Storage Lot Coverage(s)

• Number of Employees12345678910+
• Liability Limits$100,000 CSL$350,000 CSL$500,000 CSL$750,000 CSL$1,000,000 CSLBodily Injury and Property Damage
• Would you like a quote for Garagekeepers Liability?
  • Yes
  • No

  Garagekeepers Legal Liability coverage is an optional coverage designed for business owners who offer towing services or operate service stations. It protects a customer’s vehicle when you are keeping it at a covered location for parking or storing, or to perform service.

• Vehicle 1

  Please enter as much detail as possible for the most accurate rate.

• Details*
  

  Year	Make	Model

  Vin number will be requested prior to bind.

• Radius of Operations*How many miles outside your garaging address do you travel?
• Vehicle Classification*FlatbedWheel LiftIntegratedHook and ChainOther
• Vehicle Capacity*123How many vehicles can this unit tow?
• Do You Need Physical Damage?*
  • Yes
  • No

  Comprehensive and collision coverage

• Vehicle Value*
• Deductible Desired*$1,000$2,500$5,000

• Vehicle 2

  Please enter as much detail as possible for the most accurate rate.

• Details*
  

  Year	Make	Model

  Vin number will be requested prior to bind.

• Radius of Operations*How many miles outside your garaging address do you travel?
• Vehicle Classification*FlatbedWheel LiftIntegratedHook and ChainOther
• Vehicle Capacity*123How many vehicles can this unit tow?
• Do You Need Physical Damage?*
  • Yes
  • No

  Comprehensive and collision coverage

• Vehicle Value*
• Deductible Desired*$1,000$2,500$5,000

• Vehicle 3

  Please enter as much detail as possible for the most accurate rate.

• Details*
  

  Year	Make	Model

  Vin number will be requested prior to bind.

• Radius of Operations*How many miles outside your garaging address do you travel?
• Vehicle Classification*FlatbedWheel LiftIntegratedHook and ChainOther
• Vehicle Capacity*123How many vehicles can this unit tow?
• Do You Need Physical Damage?*
  • Yes
  • No

  Comprehensive and collision coverage

• Vehicle Value*
• Deductible Desired*$1,000$2,500$5,000

• Vehicle 4

  Please enter as much detail as possible for the most accurate rate.

• Details*
  

  Year	Make	Model

  Vin number will be requested prior to bind.

• Radius of Operations*How many miles outside your garaging address do you travel?
• Vehicle Classification*FlatbedWheel LiftIntegratedHook and ChainOther
• Vehicle Capacity*123How many vehicles can this unit tow?
• Do You Need Physical Damage?*
  • Yes
  • No

  Comprehensive and collision coverage

• Vehicle Value*
• Deductible Desired*$1,000$2,500$5,000

• Vehicle 5

  Please enter as much detail as possible for the most accurate rate.

• Details*
  

  Year	Make	Model

  Vin number will be requested prior to bind.

• Radius of Operations*How many miles outside your garaging address do you travel?
• Vehicle Classification*FlatbedWheel LiftIntegratedHook and ChainOther
• Vehicle Capacity*123How many vehicles can this unit tow?
• Do You Need Physical Damage?*
  • Yes
  • No

  Comprehensive and collision coverage

• Vehicle Value*
• Deductible Desired*$1,000$2,500$5,000

• Driver 1 Details

• Name*
  
  First
  
  Last
• Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920
• State Licensed*StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific
• Drivers License Number
• Moving Violations or Accidents in Past 60 Months?
  • Yes
  • No
  • Don’t Know
• MVR DetailsFor an accurate quote, please list any violations and/or accidents.

• Driver 2 Details

• Name*
  
  First
  
  Last
• Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920
• State Licensed*StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific
• Drivers License Number
• Moving Violations or Accidents in Past 60 Months?
  • Yes
  • No
  • Don’t Know
• MVR DetailsFor an accurate quote, please list any violations and/or accidents.

• Driver 3 Details

• Name*
  
  First
  
  Last
• Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920
• State Licensed*StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific
• Drivers License Number
• Moving Violations or Accidents in Past 60 Months?
  • Yes
  • No
  • Don’t Know
• MVR DetailsFor an accurate quote, please list any violations and/or accidents.

• Driver 4 Details

• Name*
  
  First
  
  Last
• Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920
• State Licensed*StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific
• Drivers License Number
• Moving Violations or Accidents in Past 60 Months?
  • Yes
  • No
  • Don’t Know
• MVR DetailsFor an accurate quote, please list any violations and/or accidents.

• Driver 5 Details

• Name*
  
  First
  
  Last
• Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920
• State Licensed*StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific
• Drivers License Number
• Moving Violations or Accidents in Past 60 Months?
  • Yes
  • No
  • Don’t Know
• MVR DetailsFor an accurate quote, please list any violations and/or accidents.

• Underwriting Questions

• Does your business have any repo or relocation operations?
  • Yes
  • No
• Does your business have any vehicles that weight over 45,000 lbs?
  • Yes
  • No
• Does your business tow any vehicles that weight over 16,000 lbs?
  • Yes
  • No
• Does your business engage in righting, extracting, or towing of vehicles containing or leaking hazardous materials or substances?
  • Yes
  • No
• Does your business belong to a professional towing association?
  • Yes
  • No
• Does your business engage in “chasing” or use police scanners?
  • Yes
  • No
• Does your business have any drivers that have a physical or medical impairment?
  • Yes
  • No
• Comments or Additional Information: