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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!

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? *

Yes
No

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
Local: 626-793-3800
Toll-Free: 888-588-6638
Fax: 626-793-3801
Email: info@hoyains.com

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