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Bus - Quick Quote


Please fill in this form as completely as possible.  Any fields left blank may cause a delay in the quoting process.  If you have any questions, do not hesitate to contact us directly.  This form may also be requested via fax or email.  Driver and Vehicle lists may be faxed separately.  Additional Drivers and Vehicles can be added over the phone or by separate fax or email.  Thank you for choosing Hoya!

  • General Information
  • Coverage Information
  • Vehicle Information
  • Driver Information
Company Information
Company Name *
First Name *
Last Name *
Primary Phone Number *
Alternate Phone Number
Fax Number
E-Mail Address *
Street *
City *
State *
ZIP / Postal Code *
Garaging Address (if different)
FMCSA #
Effective Date
/ /
Years In Business
Owner Name (First & Last)
Type of Business
Federal ID Number *
Destinations *
Radius of Operation *
Do You Have Any Losses In The Last 3 Years? *

Current Insurance Carrier
Policy Number
Annual Premium
Previous Year Insurance Carrier Name
Previous Year Policy Number
Previous Year Annual Premium
2nd Previous Year Insurance Carrier Name
2nd Previous Year Policy Number
2nd Previous Year Annual Premium
Vehicle #1 Model Year
Vehicle #1 Make/Model
Vehicle #1 VIN #
Vehicle #1 License Plate #
Vehicle #1 Annual Mileage
Vehicle #1 Seating Capacity
Vehicle #1 Value When New
Vehicle #2 Model Year
Vehicle #2 Make/Model
Vehicle #2 VIN #
Vehicle #2 License Plate #
Vehicle #2 Annual Mileage
Vehicle #2 Seating Capacity
Vehicle #2 Value When New
Vehicle #3 Model Year
Vehicle #3 Make/Model
Vehicle #3 VIN #
Vehicle #3 License Plate #
Vehicle #3 Annual Mileage
Vehicle #3 Seating Capacity
Vehicle #3 Value When New
Comprehensive Deductible
Driver #1 First Name
Driver #1 Last Name
Driver #1 Date of Birth
/ /
Driver #1 License Number
Driver #1 License State
Driver #1 License Class
Driver #1 Commercial License Years of Experience
Driver #1 Years Experience with Current Vehicle
Driver #2 First Name
Driver #2 Last Name
Driver #2 Date of Birth
/ /
Driver #2 License Number
Driver #2 License State
Driver #2 License Class
Driver #2 Commercial License Years of Experience
Driver #2 Years Experience with Current Vehicle
Driver #3 First Name
Driver #3 Last Name
Driver #3 Date of Birth
/ /
Driver #3 License number
Driver #3 License State
Driver #3 License Class
Driver #3 Commercial License Years of Experience
Driver #3 Years Experience with Current Vehicle
Do You Have Additional Drivers or Vehicles To Add? *
Additional Comments
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Important Notice
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8812 E. Las Tunas Drive
San Gabriel, CA 91776

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