Livery (For-Hire) Insurance INFO Form
PLEASE NOTE: Quote requests are not binding until confirmed in writing by Fisher Insurance Agency, Inc.  Most online requests are processed the same business day and are processed in order they are received. Please do not resend a request – contact our office at 508-853-2400 or email dhaughey@thefiai.com for a status Monday through Friday from 8am – 5pm (Eastern Standard Time).

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 INSURED INFORMATION (Include DBA)
If you are registered with the FMCSA and have an Active DOT #, the Corporate/Individual Insured Name should read exactly how it reads with the Department of Transportation otherwise filings will not go through.  View your Company snapshot at http://safer.fmcsa.dot.gov/CompanySnapshot.aspx 
Corporate/Individual Insured Name:
Insured Mailing Address:
Complete Street Address with Street # and Suite # (Example - 123 Main St. Suite # 2)
City:
State:
Zip Code:
EIN#:
Employer Identification Number (EIN) is a nine-digit number that the IRS assigns to identify taxpayers that are required to file various business tax returns.The Employer Identification number may sometimes be referred to as the Federal Tax Identification Number. (Not Social Security Number)
DOT# (if any):
Enter the USDOT number assigned by the Federal Motor Carrier Safety Administration, and that is associated with the named insured's business. The USDOT Number can be found in SAFER.
FINANCIALLY RESPONSIBLE PERSON/OWNER
Name:
The first and last name of the person who is the Owner of or Runs the Business
Date of Birth:
Date of Birth of the Owner or Person who Runs the Business
MM
/
DD
/
YYYY
Social Security Number:
Social Security of the Owner or Person who Runs the Business ***THIS IS NOT A REQUIREMENT*** But could LOWER the Rate!
Phone #
Phone # of the Owner or Person who Runs the Business
Email Address:
Email of the Owner or Person who Runs the Business
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