Transportation Insurance

Ieuter Insurance Group

In order to let us go to work for you, we will need the following information

Contact Information

Name of the Company ✶

Address ✶

Contact Name, Phone Number & Email Address ✶

FEIN #

Number of years in business

Vehicle Information

Year

Make

Model

VIN#

Seat Capacity

Stated Value

Driver Information

Name

Driver’s License #

Date of Hire

Years of Experience

Additional Information

Updated loss runs for the last 5 years (if in business that long)

Binding Agreement

I understand that insurance coverage is not bound or altered until I receive confirmation by an authorized representative of Ieuter Insurance Group ✶

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