Commercial Lines – Owned Business AutoEmet Digital2019-01-02T12:05:35-08:00 Get started by filling out this form and someone from our team will contact you shortly! Commercial - Owned Business Auto Customer InformationWhat is the name of the Policyholder (Named Insured)?* If you do not have a company, the name on the policy needs to match the name you are using for your vendors, permit offices or any other contracts that you have.What type of entity is this insurance going to be for?*Choose OneCorporationIndividual or DBAL.L.C.Non-ProfitPartnershipIn what year was your business established?* What is your business' EIN* This is your federal tax identification number. Please provide a precise description of your business operations:*Mailing Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Is this where your vehicles are garaged?* Yes No Please provide your garaging address:* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Contact Person* First Last Email* Enter Email Confirm Email Phone*What date do you want this policy to start?* MM slash DD slash YYYY Prior Insurance / ClaimsAny prior insurance?* Yes No Please provide the policy numbers, premiums and expiration dates of your prior insurance:*Any prior claims?* Yes No Please provide the dates, amounts of the claim(s) and descriptions of what happened:*Do you have loss runs that you can provide?* Yes No Please upload your loss runs here.*Accepted file types: pdf, jpg, gif, png, xls, xlxs, doc, docx, , Max. file size: 50 MB.Vehicle InformationPlease confirm that the vehicle/s you're seeking coverage for are owned by the Policyholder (Named Insured) you provided at the beginning of the application:* Confirmed I might need clarification Please advise the Year, Make, Model, VIN and Replacement Value of each vehicle you need coverage for:*Example: 2019 Honda Civic, VIN: ABC12345678910, $35,000Does your vehicle have a trailer hitch?* Yes No What kind of trailer hitch does the vehicle have?* Does your vehicle have any specialty equipment mounted or installed?* Yes No Please describe the specialty equipment and provide an estimate of its value:* Example: CB Radio - $2,500Driver InformationHow many individuals will be driving the vehicle/s?* 1 2 3 4 Anyone who drives a commercial vehicle needs to be scheduled to the policy in order for coverage to apply.Driver 1 InformationName* First Last Date of birth* MM slash DD slash YYYY Marital Status* Married, single, divorced or widowedDriver's License Number and State of Issuance* Example: CA - D58966552Driver 2 InformationName* First Last Date of birth* MM slash DD slash YYYY Marital Status* Married, single, divorced or widowedDriver's License Number and State of Issuance* Example: CA - B45896258Driver 3 InformationName* First Last Date of birth* MM slash DD slash YYYY Marital Status* Married, single, divorced or widowedDriver's License Number and State of Issuance* Example: CA - D5896552258Driver 4 InformationName* First Last Date of birth* MM slash DD slash YYYY Marital Status* Married, single, divorced or widowedDriver's License Number and State of Issuance* Example: CA - Y85989656NameThis field is for validation purposes and should be left unchanged.