NJ Business Auto Fleet Insurance Quote

In addition to Auto Fleet
Insurance for your New
Jersey business, we also
offer affordable Employee
Health Insurance plan
premiums or choose
another NJ business
insurance coverage from
the list below.

**Information received from this New Jersey Business Auto Fleet Insurance quote

request form sent to American Insurance Services Agency will be for our use only

and will not be sold, given to or distributed to any other parties. A quote will be based

on the business auto fleet insurance information provided and does not guarantee

acceptance of the risk by us. The precise coverage afforded is subject to meeting

underwriting guidelines, and the terms, conditions and exclusions of the policy as

issued. By submitting this request you acknowledge that this is neither an offer to

insure nor a guarantee of insurance. Completion of this form does not entitle you

to New Jersey Business Auto Fleet Insurance. We are licensed in New Jersey

and will not provide quotes for other states.

"Your New Jersey Business Auto Insurance Professional!"

We also offer affordable business auto fleet insurance premiums to businesses in the

following New Jersey counties and cities: Union County, Essex County, Bergen County,

Passaic County, Sussex County, Morris County, Warren County, Hunterdon County,

Somerset County, Middlesex County, Monmouth County, Mercer County, Burlington

County, Clark, Newark, Jersey City, Elizabeth, Rahway, Colonia, Iselin, Avenel,

Woodbridge, Port Reading, Carteret, Perth Amboy, Fords, South Amboy, Metuchen,

Plainfield, Dunellen, South Plainfield, Green Brook, Fanwood, North Plainfield,

Cranford, Scotch Plains, Westfield, Union, Millburn, Springfield, Mountainside, Gillette,

Warren, Watchung, Stirling, Millington, Middlesex, Martinsville, Piscataway, Edison,

New Brunswick, Highland Park, North Brunswick, Sayreville, East Brunswick,

Somerset, Milltown, South River, Bound Brook, Somerville, Bridgewater, Bayonne,

Linden, Roselle, Hoboken, Union City, Weehawken, West New York, Guttenberg,

Cliffside Park, Edgewater, North Bergen, Secaucus, Fairview, Ridgefield, Fort Lee,

Leonia, Palisades Park, Englewood Cliffs, Englewood, Bergenfield, Teaneck, Paramus,

Bogota, Ridgefield Park, Little Ferry, Hackensack, Maywood, Teterboro, South

Hackensack, Rochelle Park, Moonache, Lodi, Hasbrouck Heights, Saddle Brook,

Garfield, Elmwood Park, Woodridge, Carlstadt, East Rutherford, Lyndhurst, Rutherford,

Wallington, Passaic, Clifton, Paterson, Totowa, West Paterson, Little Falls, Great Notch,

North Caldwell, Cedar Grove, Verona, Montclair, Bloomfield, West Orange, Glen Ridge,

Belleville, Nutley, Kingsland, North Arlington, Kearney, Harrison, East Orange, East

Newark, Orange, Irvington, South Orange, Hillside, Townley, Livingston, Wayne,

Trenton, Camden, Atlantic City, Princeton, Vineland, Willingboro, and Toms River, NJ.

Business Name:
Premises Address:
City:     State:     Zip Code:
Contact Name:
Phone #:    Ext #:
Fax:    Years in Business:
Email Address: (Required)
Federal Employer's ID #:
Description of Operations or SIC code:

Vehicle     Year           Make                Model                 Body Type
     1
     2
     3
     4

What type of air bag system is each vehicle equipped with?
Vehicle
     1
     2
     3
     4

What type of anti-lock brake system is each vehicle equipped with?
Vehicle
     1
     2
     3
     4

Does each vehicle have an alarm?
Vehicle
     1
     2
     3
     4

                      Liability                    Uninsured                                             Collision         Comprehensive
Vehicle    Limits(x $1,000)      Motorist(x $1,000)       Medical              Deductible           Deductible
     1
     2
     3
     4

                                  Drivers                          Date of                                              Drivers
Driver                       Name                               Birth                  Gender                 License #
     1
     2
     3
     4

Is each employee's driving record accident & violation free during the past 5 years?
Driver
     1       If No, how many accidents?    How many violations?
     2       If No, how many accidents?    How many violations?
     3       If No, how many accidents?    How many violations?
     4       If No, how many accidents?    How many violations?

Was any employee's driver's license suspended during the past 5 years?
Driver
     1
     2
     3
     4

Other Insurance Company Used Within Past 3 Years:
Policy #:
Losses past 3 years:
Description of losses or loss runs:

Additional Information or Comments

Click on the "Submit Quote Information" button below to send your
New Jersey Business Auto Insurance quote request.**

New Jersey Business Information:

New Jersery Business Auto Fleet Insurance Coverage Information:

Vehicle Information:

Driver Information:

Recent Insurance Information: