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Privacy Policy-We routinely collect personal and/or business information that is needed as part of the quoting and underwriting process.  We also collect the same information as part of service and update activities.  The Haines & Haines/T.C. Irons Agency will not share that information, or use it in any other way, with outside parties, vendors, etc.

Commercial Auto Insurance Quotation

 

GENERAL INFORMATION
Exact Name on Registration
Type of Business
Description of Operations
Tax ID
Vehicle Use Description
Any Personal Use? Yes No
Do You Require Permits/Filings? Yes No
Garaging Address
Garaging City
State
Zip Code
Are You A Trucker for Hire? Yes No
if YES Answer the following
  Do You Haul Hazmat? Yes No
  Contract with Only One Company? Yes No
  Commodities Transported  

CURRENT POLICY INFORMATION
Currently Insured?
 Yes No
Current/Prior Carrier
If Not Currently Insured
When did Coverage End?

How long have you been
CONTINUOUSLY Insured?
Current Policy Term


Current Policy Expiration Date
Current Policy Premium
 
Current Limits of
Liability		 $60,000
$100,000 $300,000
$500,000 $1,000,000

IMPORTANT
NOTE


If you own more than one commercial vehicle or maintain a fleet of commercial vehicles:

- Select this box ;
- Go to bottom of this page and;
- Submit this form.

A Commercial Fleet Representative will contact you directly. - You may qualify for our Low Cost COMMERCIAL FLEET PROGRAM.

 

DRIVER #1 INFORMATION
Name Birth date
Sex (M/F) # Years U.S.
 Licensing
In order to obtain all available DISCOUNTS and an accurate rate, carriers run an MVR Report. Provide Driver's License #, so that we can obtain the LOWEST RATE AVAILABLE!
Driver 1 Driver's
License #:		 State or Country
of License:

 

DRIVER #2 INFORMATION
Name Birth date
Sex (M/F) # Years U.S.
 Licensing
In order to obtain all available DISCOUNTS and an accurate rate, carriers run an MVR Report. Provide Driver's License #, so that we can obtain the LOWEST RATE AVAILABLE!
Driver 2 Driver's
License #		 State or Country
of License

 

DRIVER #3 INFORMATION
Name Birth date
Sex (M/F) # Years U.S.
 Licensing
In order to obtain all available DISCOUNTS and an accurate rate, carriers run an MVR Report. Provide Driver's License #, so that we can obtain the LOWEST RATE AVAILABLE!
Driver 3 Driver's
License #		 State or Country
of License

 

VEHICLE INFORMATION
(if "Non-Owners", type "NON-OWNER" in "YEAR" Field)
Year of Vehicle Make
Model
Sub Model (EX,LX, etc.)
Truck Alterations or Customizations? Y   N
Do You Own Other Vehicles? Y   N
GROSS Weight fully Loaded
Cost New Usage
Est Annual Mileage Vehicle ID/VIN
VEHICLE COVERAGE:
BI-GP-PD
(See Definitions)		 $ 60,000
$100,000     $300,000
$500,000     $1,000,000
For  FULL COVERAGE  Please Select a Deductible Below:
Comprehensive
& Collision		 NO Coverage
$500 Deductible      $1,000 Deductible
$2,500 Deductible   $5,000 Deductible

 CONTACT INFORMATION
First Name

Last Name

Email

Phone                        Fax
  
Questions / Comments / Notes
Send my quotation via E-Mail Fax
Regular Mail
Call me by Phone!

All quotes are based on the information that the applicant  provides, and are subject to change based on final underwriting by the  individual carriers.


Our Mission Statement
Dating back from 1872 our mission is clear:
To serve our clients with the utmost respect, integrity and professionalism while providing a comprehensive risk management program at competitive pricing
 


Get a Quote

Contactenos ahora, hablamos su idioma.

 

 

Policy Coverage
and Disclaimer


  Haines & Haines/ T.C. Irons  
16 West Front Street
Florence, NJ 08518
Phone: 609.499.0237 
Fax: 609.499.4077		 230 High Street PO Box 158- Burlington, NJ 08016
Phone: 609.387.0606
Fax: 609.387.5337
 1-3 Bank Street
Suite E
Medford, NJ 08055
Phone: 609-953-2282 
Fax: 609.953.7719
  Wesley Insurance Service Agency
1194 Parkway Avenue Trenton, NJ 08628
Phone: 609.883.4190
Fax: 609.538.0274