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Elite Transportation Insurance Corp.
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Elite Transportation Insurance Corp.
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As brokers we represent a number of insurance companies offering very competitive rates for automobile insurance. Along with their competitive rates they provide excellent claims service, discounts for multi-policy, multi-vehicle, mature and non-drinkers. Please take a few moments and fill out the questionnaire below. We will provide you with a quotation within 2 business days.

First Name:
Last Name:
Address:
City:
Postal Code:
Phone:
E-Mail:
Policy Renewal Date:
Policy Cancelled in last 3 years:
Date:
Reason:
 
Vehicle Information
Vehicle #1
Vehicle #2
Vehicle #3
Year:
Make:
Model:
Body Type:
Liability:
Collision Deductible:
Comprehensive Deductible:
Loss of Use
 
Driver Information
Driver #1 Driver #2 Driver #3
Driver Age:
Sex:
Licensed Class:
Date Licensed Month/Year:
Licensed Suspended:
If Yes give date
Date Suspended:
Approved Driver Training:
# of years insured:
Use:
Commute to work or school
Distance one way (KM):
Annual KM:
Violations past 3 years
Date:
Type:
If Speeding, list # of KM over limit
KM:
Accidents, Occurences or Claims past 6 years:
Date:
Type:
contractor insurances