HAYES INSURANCE AGENCY

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Commercial Auto

This questionnaire is used to obtain information about your business operations. In most cases, we will need to obtain more information from you to provide you with an accurate quote.

The online questionnaires are a starting point and are very helpful in our quoting process. Please try to be as accurate as possible when answering these questions. Thank you
First Name
Last Name
Company Name
Address Line 1
Address Line 2
City
State
Zip Code
Daytime Phone() -
Fax() -
E-mail Address
# of Vehicles
Year, Make, Vin # of all vehicles to be insured
Continued from above question
# of miles driven annual
Type of business operations
Are you currently insured?
Any claims in the last 3 years?
Name, Birthdate, Lic. # of all drivers
Continued from above
How long have you been in business
Comments and/or additional information
Please give the name of the broker you are working with (if any)