Commercial Auto/Local Insurance – Capital Partners Insurance Agency, Inc

Capital Partners Insurance Agency, Inc

Call Us Toll Free

(800) 889-7162

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Call Us Toll Free

(800) 889-7162

Home
About Us
Products
Applications
Contact

Commercial Auto/Local Insurance

Commercial Auto Questionnaire Form:

Thank you for allowing Capital Partners Insurance Agency, Inc. the opportunity to save you money on your insurance. Please fill out the information below and click the "submit" button.
Company Name:
Name

First NameLast Name
Phone Number

Area CodePhone Number
US DOT #:
How many years have you been in business?
Business FEIN Number: (Business TAX ID Number)
Address for where you park the TRUCK overnight:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
List all types of cargo hauled:
Can Foods, Electronics, Steel
Which states do you operate:
Only CA or 48 States
Driving Radius:

0-100 mi100-300 mi301-500 mi501-750 mi750 + mi
ANNUAL REVENUES:
$120,000 (1 year gross income)
Do you pull double trailers?

YESNO
Do you pull triple trailers?

YESNO
What is the basis for driver(s) pay?

HourlyTripMileageOther
Driver Name: Date of Birth: License #: State Licensed:
VIN Number: Vehicle Stated Value:
Should be Empty:

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Capital Partners Insurance Agency, Inc / CA Ins License #:6012780

369 S Doheny Dr. Suite 207 Beverly Hills, CA 90211

Phone: (800) 889-7162 Fax: (888) 248-7333

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