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HOUSEHOLD / OFFICE MOVERS ONLINE QUOTE
Commodity:
Agency Information
Agent Name:
Agency Name:
Agent Email Address: (A copy of the quote will be sent to this address)
Insured Information
Insured Name:
Insured Address:
Insured City:
Insured State:
Insured Zip:
Cargo Details
Please input a limit
Does the insured require Cargo Filings?
State?
Federal?
Risk Details
What is the Radius of Operations?
Number of Power Units:
Number of Drivers:
Type of vehicle used to transport cargo:
Has the Insured Had More Than 2 Losses in the Last 3 Years?
Has Any One Loss Been More Than $5,000?
Has insurance been canceled within the last 5 years?
GL Information
Would the insured like GL coverage?
Please note that all quotes are subject to acceptable MVRs. Drivers with multiple violations, any major violation or accidents, and lack of proper experience may not be eligible.

Any questions or problems with the form? Please contact Elizabeth Scott 800-396-6226 x102


Only Commonwealth Underwriters, Ltd. has binding authority. Coverage will not be bound until application has been received, reviewed, and accepted by Commonwealth Underwriters, Ltd.


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Contact Commonwealth Underwriters
Phone: 800-396-6226
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Last modified 2007-12-05