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phone: 413-732-5465
fax: 413-732-5450
John@JRSIns.com
1233 Westfield St, Suite 1
West Springfield, MA 01089
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Request a Quote: Commercial Auto
Contact Information
Name *
Company Name
Address
City, State, Zip
Phone
Fax
Email *
Best Contact Method
Email
Phone
Fax
USMail
Best Time to Call
Tax ID: (SSN or FEIN)
Vehicle(s)
Vehicle 1
Vehicle 2
Year
Make
Model
VIN
Cost New
Gross Vehicle Weight
Radius of Operation
Garaging
Type of Use
Driver(s) - List all licensed drivers in your household.
Name on License
Date of Birth
License Number
State
Driver Training
1.
Yes
No
2.
Yes
No
3.
Yes
No
4.
Yes
No
5.
Yes
No
6.
Yes
No
Coverages
Liability
20/40
50/100
100/300
500/500
1000/1000
Collision Deductible
300
500
1,000
Comprehensive Deductible
300
500
1,000
Disclaimer - We will provide an estimated quote based on the information you provide. Actual premiums may vary due to additional or updated data received during the final underwriting process. A quote does not provide or guaranty insurance coverage. Insurance coverage can only be bound by an authorized agent upon receipt of down payment and signed application.
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