您偏好的溝通語言 Preferred Language*
需要新估價的原因 Reason for New Quote*
您是如何得知我們的？How did you hear about us?*
已投保商業責任險？Carry a General Liability Policy?*
是否曾有事故紀錄 Any known prior claim?*
車輛是否用於送貨或取貨？Is the vehicle used for deliveries or to pick up goods?*
車輛是擁有、貸款還是租賃？Is the vehicle own / loan / lease?*
車輛是否用於送貨或取貨？Is the vehicle used for deliveries or to pick up goods?
車輛是擁有、貸款還是租賃？Is the vehicle own / loan / lease?
Prior Accident or Ticket? 曾有事故或違規？*
Prior Accident or Ticket? 曾有事故或違規？
業務作業相關資訊 Operational Details
是否需要州或聯邦保險登記，或需要 MCS-90 表格？Are state or federal insurance filings or an MCS-90 required?*
是否涉及運送危險物品? Do any operations involve transporting hazardous materials?*
是否每年在其他州工作超過90天？Do any operations involve work in another state for more than 90 days per year?*
是否有車輛為公司持有或常用，但未列在本申請表中？Any vehicle owned or available for regular use but not scheduled on the application?*
是否有車輛會用於載客或是送餐（如 Uber、Lyft、DoorDash 等）？Will any covered vehicle be used to transport passengers for hire OR deliver property for compensation or fee, including transportation network companies and on-demand delivery services?*
駕駛人在過去10年內是否曾因詐欺或重罪被判刑？Has any driver ever been convicted of a criminal offense involving fraud, or any felony during the last 10 years?*
若您需要填寫更多額外的駕駛人或是車輛資料，請寫在備註欄。
If you need to provide additional driver or vehicle information, please write it in the Additional Notes section.
請選擇指定的經紀或是客服人員 Please select a designated agent or customer service representative.*
