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Welcome to Mullen Insurance Agency Inc.

 

Which quote sheet should I use?

If the vehicle is a private passenger vehicle, use the Business Auto.  This class includes:

Cleaners, pickup & delivery - Bakeries - Grocery Delivery - Realtors - Salesmen - Florists, etc.

 

Business Auto

Quick Quote Sheet

 

Applicant Information            
I am:  Producer Name:
Not available to Agents at this time.

Customer Information            
Name: Social Security #:
DBA: Years in Business:
Address: Effective Date Desired:
City: Phone:
County: Fax:
State: Must be based in Texas. email:
Zip:
Description of your business:

Vehicles                                    
# Year Make VIN GVW ACV
1
2
3
4
5

Drivers                                             
# Name DOB CDL Number/State Years Experience Date of Hire MVR Info
1
2
3
4
5

Coverages                                                     
Liability ? Liab CSL U/M PIP

Physical       

Damage?

 Comp Ded         SCOL Ded Coll Ded
MC# USDOT#
Radius
Commodities Hauled &   percent of each

3-Year Prior Carrier and Loss History 

if no losses, say NONE or NA
Carrier Loss amount & description 
Expiring
1st Prior
2nd Prior

Additional Information
Need a Fax Check Form?

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