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 *

Last Name *

Business Name *

Business Type *

Tax ID or Social Security # *

Years in Business *

Street *

City *

State *

ZIP / Postal Code *

Primary Phone Number *

E-Mail Address *

Gender *

Date of Birth *

Vehicle #1

VIN # (If not available type N/A) *

Liability Limits *

Comprehensive Deductible *

Collision Deductible *

Do you want glass coverage? *

Do you want rental reimbursement? *

Vehicle #2

Vehicle 2 VIN

Comprehensive Deductible

Collision Deductible

Vehicle #3

Vehicle 3 VIN

Comprehensive Deductible

Collision Deductible

Vehicle #4

Vehicle 4 VIN

Comprehensive Deductible

Collision Deductible

Name (First & Last) *

Vehicle Used *

Marital Status *

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

Years Licensed *

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

Do you have a CDL License? *

Primary Use *

Current Vehicle Value *

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

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

Currently Insured *

If no, when did you last have insurance?

Current Insurance Provider (If No Prior Insurance select NONE)

Current Expiration Date *

Driver #2

Name (First & Last)

Vehicle Used

Relationship

Gender

Marital Status

Date of Birth

Driver #3

Name (First & Last)

Vehicle Used

Relationship

Marital Status

Date of Birth

Driver #4

Name (First & Last)

Vehicle Used

Relationship

Gender

Marital Status

Date of Birth

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.

Per the terms of our online privacy policy we will not resell your information to any third-party.

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