Tow Truck Quick Quote Form

Applicants Name: Business Name:

Mailing Address: City: ZIP:

Garaging Address: City: ZIP:

DESCRIBE BUSINESS OPERATIONS & TYPE OF VEHICLES BEING TOWED

Do all drivers listed have a minimum of 3 years experience driving tow trucks?

How many years prior insurance under the business name listed above? MCP FILING CA#

PRIOR INSURANCE INFORMATION
Eff dates (month/year) Company Name # of Losses Paid Out Annual Premium
Current
Year Prior
Year Prior
COVERAGE ON-HOOK COVERAGE
Liability Limits: Medical UM Limit:





*New Ventures eligible for only $25,000
DRIVERS SCHEDULE - MVR MUST BE ATTACHED IN ORDER TO QUOTE
Name Class Lic. Date of Birth Years Tow Truck Exper Past 36 Months
# Accidents # Moving # Non-Moving
1
2
3
4
5
6
7
8
+ More Fields
TOW TRUCK TYPE *5+ units require completed app & 3 years loss runs Physical Damage
Year Make - Model Body Type (see below) VIN # Radius Stated Value Deductible
1
2
3
4
5
6
7
8
+ More Fields
(optional)