Business Auto & Truck

Fill out the form below to receive your Free Business Auto & Truck Proposal. A qualified insurance representative will be in touch within 24 hours, with the answers you need to make an informed decision.

Name *

Company	Email *

Phone	Fax

County	Zip

Limits Requested

Medical Pay

Comprehensive Deducible

Collision Deducible

Uninsured Motorists

Hired/Non-Owned

Currently Insured?

My Policy Renews: (Current date if not insured)
Month
Year

1st Vehicle
Year

Make	Model

Cost New

Zip (Garaging Address)

2nd Vehicle
Year

Make	Model

Cost New

Zip (Garaging Address)

3rd Vehicle
Year

Make	Model

Cost New

Zip (Garaging Address)

4th Vehicle
Year

Make	Model

Cost New

Zip (Garaging Address)

5th Vehicle
Year

Make	Model

Cost New

Zip (Garaging Address)

If you have more than five autos to quote, please provide the above information for each auto and fax it to
800-823-7205

How to Purchase

Business Hours
( 9am-5pm )

Call us Toll Free
(800) 888-2249

After Hours

Click the button below and we will call you first thing in the morning!

Indiana Contractors Insurance div of Quality Insurance Services
212 Tracy Rd., New Whiteland, Indiana 46184, Phone 317-535-1979, Toll Free 800-888-2249