IMPORTANT INFO:
In addition to submitting this form online, this form can be printed and faxed to:
Fax: (212) 937-3923

or call today for an
EXPRESS PHONE QUOTE:
888-ARMofNY (276-6369)
and talk to an insurance specialist.

- LOW PRICES
- LOW DOWN PAYMENT
- LOW MONTHLY PAYMENTS
- IMMEDIATE COVERAGE
- "A+" RATED CARRIERS
- PROFESSIONAL SERVICE
- PAYMENT PLANS
- CREDIT CARDS

COVERAGE DEFINITIONS Bodily Injury-Guest Passenger (BI-GP) Pays when an insured person is legally liable (responsible) for bodily injury or death caused by your vehicle or your operation of most non-owned vehicles. This coverage also pays for your legal defense if you are sued. Property Damage (PD) Pays when an insured person is legally liable (responsible) for damage to the property of others caused by your vehicle and your operation of most non-owned vehicles. This coverage also pays for your legal defense costs if you are sued. Comprehensive and Collision Comprehensive and Collision coverage covers the cost to repair or replace your motorcycle if it is stolen or damaged in an accident, regardless of who is at fault. You select a deductible* for each coverage, and once the deductible is met, the insurance company pays for the remaining damage. Note: A deductible is the amount you as the policy holder will pay. Under Collision Coverage, your insurance company pays for damage to your vehicle when you collide with another vehicle or object. Under Comprehensive Coverage, your insurance company pays for damage to your vehicle caused by an event other than a collision, such as fire, theft or vandalism.

Commercial Auto Insurance Quote

Our new customers report saving 15%-30%.*

Do you want to save on your insurance?

Find out now - get a quote!

Our satisfaction is saving you money.   We make it easy for you to save and keep money where it belongs . . . In your pocket for more important needs - Your Business!

For faster service refer to a copy of current policy.
New policy?  Have driving history for all drivers available.

GENERAL INFORMATION
Your Name:
Exact Name on Registration:
Type of Business:
Description of Operations:
Tax ID:
Vehicle Use Description:
Any Personal Use:	Yes No
Do You Require Permits/Filings?	Yes No
Garaging Address:
Garaging City:
State:	NY, NJ & PA Only!
Zip Code:
E-Mail (REQUIRED):
Phone:
Are You A Trucker for Hire?	Yes No
if YES Answer the following:
Do You Haul Hazmat?	Yes No
Contract with One Company?	Yes No
Commodities Transported:
CURRENT POLICY INFORMATION
Currently Insured? Yes No
Current/Prior Carrier?
If Not Currently Insured When did Cvg. End?	N/A 0-30 Days 31 Days or More
How long have you been CONTINUOUSLY Insured?	N/A Less Than 6 Months 6 Months - 1 Year Over 1 Year
Current Policy Term	N/A 6 Months 1 Year
Current Policy Expiration Date
Current Policy Premium
Current Limits of Liability:	$60,000 $100,000 $300,000 $500,000 $1,000,000
IMPORTANT NOTE	If you own more than one commercial vehicle or maintain a fleet of commercial vehicles: - Select this box ; - Go to bottom of this page and; - Submit this form. A Commercial Fleet Representative will contact you directly. - You may qualify for our Low Cost COMMERCIAL FLEET PROGRAM.

DRIVER #1 INFORMATION
Name:		Birthdate:
Sex (M/F):	Select . . . Female Male	# Years U.S.  Licensing:
In order to obtain all available DISCOUNTS and an accurate rate, carriers run an MVR Report. Provide Driver's License #, so that we can obtain the LOWEST RATE AVAILABLE!
Driver 1 Driver's License #:		State or Country of License:

DRIVER #2 INFORMATION
Name:		Birthdate:
Sex (M/F):	Select . . . Female Male	# Years U.S.  Licensing:
In order to obtain all available DISCOUNTS and an accurate rate, carriers run an MVR Report. Provide Driver's License #, so that we can obtain the LOWEST RATE AVAILABLE!
Driver 2 Driver's License #:		State or Country of License:

DRIVER #3 INFORMATION
Name:		Birthdate:
Sex (M/F):	Select . . . Female Male	# Years U.S.  Licensing:
In order to obtain all available DISCOUNTS and an accurate rate, carriers run an MVR Report. Provide Driver's License #, so that we can obtain the LOWEST RATE AVAILABLE!
Driver 3 Driver's License #:		State or Country of License:

VEHICLE INFORMATION (if "Non-Owners", type "NON-OWNER" in "YEAR" Field)
Year of Vehicle:		Make:	Select Make . . . Acura Alfa Romeo AM General American Motors Aro Aston Martin Audi Austin Rover Avanti Bertone BMW Buick Cadillac Capri Checker Chevrolet Chrysler Daihatsu Datsun Delorean Dodge Eagle Ferrari Fiat Ford Geo GMC Honda Hyundai Infiniti International Isuzu Jaguar Jeep KIA Lancia Land Rover Lexus Lincoln Lotus Maserati Mazda Mercedes-Benz Mercury MG Mitsubishi Nissan Oldsmobile Opel Peugeot Plymouth Pontiac Porsche Renault Rolls Royce Rover Saab Saturn Sterling Subaru Suzuki Toyota Triumph TVR Volkswagen Volvo Yugo Not Listed
		Model:
		Sub Model:	(EX,LX, etc.)
Truck Alterations or Customizations?			Y   N
Do You Own Other Vehicles?			Y   N
GROSS Weight fully Loaded:
Cost New:		Usage:	Select Radius . . . Less Than 50 Miles 50 to 100 Miles More Than 100 Miles
Est Annual Mileage:		Vehicle ID/VIN
VEHICLE COVERAGE:
BI-GP-PD: (See Definitions)	$ 60,000 $100,000     $300,000 $500,000     $1,000,000
For  FULL COVERAGE  Please Select a Deductable Below:
Comprehensive & Collision:	NO Coverage $500 Deductible      $1,000 Deductible $2,500 Deductible   $5,000 Deductible

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Comments or Remarks: (List additional drivers, autos, etc. here)
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Thank you for filling out this form COMPLETELY! ARM-Capacity's Policy on sharing information: We will only use information provided to assist in obtaining appropriate insurance quotes and coverage. We will not distribute information to other parties other than for insurance underwriting purposes. *Average reported savings based on ARM of NY survey data through July 2005. Please Send Me an Auto Quote NOW!

Click Button Below When Done OR PRINT AND FAX THIS FORM TO FAX: 212.937.3923 or Call: 888.ARMofNY - 888.276.6369 for an Express Phone Quote!