small business health insurance quote
Start with what you know. We can help with missing vehicle, driver, or coverage details.
Required fields are marked *. This is a request for an agent review.
1. Business2. Vehicles3. Coverage4. Contact
Legal business name * Use your name if you are a sole proprietor.
What does your business do? * For example: landscaping, plumbing, or delivery.
Primary garaging state * Choose oneAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
ZIP where vehicles stay overnight *
Years in business * Enter 0 for a new business.
Street address where vehicles stay overnight (optional)
Garaging city (optional)
DBA / trade name (optional)
Business structure (optional) Choose oneSole proprietorLLCCorporationPartnershipNonprofitOther / not sure
Business / mailing street address (optional) Provide this separately from the vehicle garaging address.
Business / mailing city (optional)
Business / mailing state (optional) Choose oneAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
Business / mailing ZIP (optional)
Additional garaging locations (optional) List each address or ZIP and the vehicles kept there.
Number of vehicles to insure * Enter 0 if you only use rented or employees' vehicles.
Number of people who will drive * Enter 0 if drivers have not been selected yet.
Main vehicle use * Choose oneService calls / my own tools or goodsDelivery / courierFor-hire freight / truckingPassengers / rideshare / NEMTTowing / vehicle transportOther / more than one use
Farthest one-way trip from base * Choose one0-50 miles51-100 miles101-200 miles201-500 milesMore than 500 milesNot sure
Do vehicles travel across state lines? * Choose oneYesNoNot sure
Use rented or employees' personal vehicles? * Choose oneRented vehiclesEmployees' personal vehiclesBothNeitherNot sure
What do you deliver, and for which platforms or customers? (optional)
Cargo / commodities hauled (optional)
USDOT / MC number, if known (optional)
Operating authority / lease arrangement (optional) Choose oneMy own authorityLeased to another motor carrierApplication pendingNot sure
Passenger service (optional) Choose oneTaxi / livery / limousineRideshare appNon-emergency medical transportationShuttle / other passenger service
Maximum passengers per vehicle (optional)
Wheelchair or stretcher transportation? (optional) Choose oneWheelchairStretcherBothNeitherNot sure
Describe your towing or transport operations (optional) Include whether you store customer vehicles or do repossessions.
Describe all vehicle uses (optional)
An agent will review rented and employee-owned vehicle exposures and any vehicle damage coverage you need.
Add another vehicle
Vehicle list (optional) Year, make, model, VIN if handy, registered owner, owned/financed/leased, approximate value, and annual miles. One vehicle per line.
Trailers, heavy vehicles, or attached equipment (optional) Include weight ratings, trailers, refrigeration, lifts, or other modifications if known.
Leave dates of birth and license numbers for secure follow-up.
Add another driver
Driver names, license states, and experience (optional)
When would you like coverage? * Choose oneAs soon as possibleI have a date in mindAt my next renewalJust exploring options
Requested start date (optional)
Current auto insurance * Choose oneCommercial auto policyPersonal auto policyNo current policyLapsed / canceled / nonrenewedNot sure
When did coverage end, and why? (optional) Approximate date and reason, or Not sure.
Liability limit to discuss * Choose oneHelp me chooseMatch my current policy$500,000 combined single limit$1 million combined single limitContract requires another amount
Required limit, requesting organization, and deadline (optional) Tell us what you know; the agent can review the contract.
Vehicle damage coverage (optional) Choose oneHelp me chooseYes - discuss comprehensive and collisionNo - discuss liability coverageMatch my current policy
Auto claims in the past 3 years? * Choose oneYesNoNot sure
Driver accidents or violations in the past 3 years? * Choose oneYesNoNot sure
Brief claims / driving-history details (optional) Approximate date and driver or vehicle involved, or Details to follow.
Current insurer (optional)
Policy expiration date (optional)
Preferred vehicle damage deductible (optional) Choose oneHelp me chooseMatch current policy$500$1,000$2,500Other
Contract, lender, cargo, trailer, or filing requirements (optional) Include a certificate deadline or required limit if known. An agent will confirm what is needed.
I have a policy or vehicle list and would like help sharing it.
First name *
Last name *
Email *
Phone *
Preferred contact method (optional) Choose oneEmailPhone callEither
Best time to reach you (optional) Include your time zone.
Phone extension (optional)
Anything else we should know? (optional) Please leave Social Security numbers, dates of birth, license numbers, and payment information for secure follow-up.
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Year Make and model VIN, if available Registered owner Ownership Choose oneOwned outrightFinancedLeasedOther / not sureApproximate value ($) Annual miles Different garaging address, if any
Driver name License state Years of relevant experience CDL class / years held, if applicable
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