Connecticut Business Auto Insurance Quotes

**Information received from this Connecticut Business Auto Insurance quote request form sent to ConnDriver.com/Stamford Insurance Group 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 insurance policy 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 your Connecticut business to an Auto Fleet Insurance Policy. We are licensed in Connecticut, New York, New Jersey and Rhode Island, and will not provide quotes for other states.

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
     5

What type of air bag system is each vehicle equipped with?
Vehicle
     1
     2
     3
     4
     5

What type of anti-lock brake system is each vehicle equipped with?
Vehicle
     1
     2
     3
     4
     5

Does each vehicle have an alarm?
Vehicle
     1
     2
     3
     4
     5

                      Liability                    Uninsured                                             Collision         Comprehensive
Vehicle    Limits(x $1,000)      Motorist(x $1,000)       Medical              Deductible           Deductible
     1
     2
     3
     4
     5

                                  Drivers                          Date of                                              Drivers
Driver                       Name                               Birth                  Gender                 License #
     1
     2
     3
     4
     5

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?
     5       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
     5

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 Connecticut Business Auto Insurance quote request.**

We are your local Connecticut insurance agency, offering experienced
auto insurance coverages to businesses in the following Connecticut cities
and counties: Stamford, Norwalk, Greenwich, Darien, Riverside,
Belltown, Springdale, Round Hill, Old Greenwich, East Norwalk,
New Canaan, Glenville, Byram, Cos Cob, Mianus, North Stamford,
Glenbrook, Wilton, Weston, Long Ridge, Noroton,
West Norwalk, Westport, High Ridge, Southport, North Wilton,
Winnipauk, Cannondale, Turn of River, South Wilton, Lyons Plains,
Georgetown, Ridgefield, Branchville, Redding, Topstone, Ridgebury,
Redding Ridge, Branchville, Dodgingtown, West Redding, Titicus,
Hattertown, Bethel, Danbury, New Fairfield, Newtown, Hawleyville,
Botsford, Monroe, Bridgeport, Stepney, Shelton, Huntington, Upper
Stepney, Long Hill, Trumbull, Stratford, Easton, Fairfield, Greenfield
Hill, Stratfield, Nichols, Oronoque, Rivercliff, Devon, Lordship, and
East Bridgeport, New Haven, Hartford, Torrington, Waterbury,
Meriden, New Britain, New London, Norwich, Manchester, East
Hartford, Suffield, Granby, West Haven, West Hartford, Branford,
East Haven, Hamden, Woodbridge, Orange, North Haven, Groton,
Rocky Hill, Newington, Wethersfield, Glastonbury, Bloomfield, Blue
Hills, South Windsor, Naugatuck, New Hartford, Chesire, East Lyme,
Old Mystic, Wallingford, Southington, Middletown, Bristol, Laurel
Beach, Litchfield, Pleasure Beach, Mystic, North Westchester,
Double Beach, Willimantic, Storrs, Canaan, East Windsor, Vernon,
South Canaan, Putnam, Guilford, Windham, South Britain, Willington,
Windsor, East Hampton, Brooklyn, Westchester, Fairfield County,
New Haven County, Litchfield County, Middlesex County, New London
County, Hartford County, Tolland County, and Windham County, CT.