Formerly Stop Agency, Inc. - Same Faces & Great Service since 1996

Commercial Auto Insurance Quote

Fill out the following form as completely as possible. Once you have completed the form, click the Submit button to send your information. Your request will be handled promptly.

Personal Information

First Name

Required

Last Name

Required

Business Name

Required

Business Type

Required

Tax ID or Social Security #

Required

Years in Business

Required

Street

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City

Required

State

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ZIP / Postal Code

Required

Primary Phone Number

Required

E-Mail Address

Required

Gender

Required

Date of Birth

Required

Vehicle #1

Optional

VIN # (If not available type N/A)

Required

Liability Limits

Required

Comprehensive Deductible

Required

Collision Deductible

Required

Do you want glass coverage?

Required

Do you want rental reimbursement?

Required

Vehicle #2

Optional

Vehicle 2 VIN

Optional

Comprehensive Deductible

Optional

Collision Deductible

Optional

Vehicle #3

Optional

Vehicle 3 VIN

Optional

Comprehensive Deductible

Optional

Collision Deductible

Optional

Vehicle #4

Optional

Vehicle 4 VIN

Optional

Comprehensive Deductible

Optional

Collision Deductible

Optional

Name (First & Last)

Required

Vehicle Used

Required

Marital Status

Required

If married, please list spouse name and address. If single, please type N/A.

Required

Years Licensed

Required

Have you had any tickets or accidents in the past 40 months? If no type None. If so please list and include conviction date.

Required

Do you have a CDL License?

Required

Primary Use

Required

Current Vehicle Value

Required

Attached Equipment Type & Value (If None, please type N/A)

Required

Have you completed a Defensive Driving Course within the past 3 years?

Required

Currently Insured

Required

If no, when did you last have insurance?

Optional

Current Insurance Provider (If No Prior Insurance select NONE)

Optional

Current Expiration Date

Required

Driver #2

Name (First & Last)

Optional

Vehicle Used

Optional

Relationship

Optional

Gender

Optional

Marital Status

Optional

Date of Birth

Optional

Driver #3

Name (First & Last)

Optional

Vehicle Used

Optional

Relationship

Optional

Marital Status

Optional

Date of Birth

Optional

Driver #4

Name (First & Last)

Optional

Vehicle Used

Optional

Relationship

Optional

Gender

Optional

Marital Status

Optional

Date of Birth

Optional

Submission Validation

Required

Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

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862D Montauk Hwy | Shirley, NY 11967 | Phn: 631.395.1000 | Fx: 631.395.1982