Auto Insurance Quote Maryland Business

We are a Baltimore, Maryland full service insurance agency, offering
comprehensive Maryland commercial auto insurance plan quotes to
businesses located in the following neighborhoods, cities and
counties: Federal Hill, Locust Point, Canton, Fells Point, Bolton Hill,
Butchers Hill, Dundalk, Essex, Baltimore Highlands, Lansdowne,
Middle River, Rosedale, Arundel Village, Brooklyn Park, Kenwood,
Eastpoint, North Point, Chesaco Park, Rossville, Halethorpe,
Elkridge, Linthicum, Glen Burnie, Rippling Ridge, Garland, Ferndale,
Woodlawn Heights, South Gate, Severn, Catonsville, Shipley,
Arbutus, West Edmondale, High Point, Riviera Beach, Green Haven,
Orchard Beach, Lipins Corner, Ellicott City, Lochearn, Brighton,
Woodmoor, Rockdale, Lynne Acres, Pikesville, Randallstown, Owings
Mills, Garrison, Towson, Mays Chapel, Overlea, Parkville, Carney,
Perry Hall, Elmwood, Edgemere, North Point Village, Rodgers Forge,
Ruxton, Linhigh, Fullerton, Putty Hill, Baynesville, Lutherville-
Timonium, Annapolis, Columbia, Hampton, Providence, Montgomery
County, Carroll County, Prince Georges County, Howard County,
Anne Arundel County, Harford County, and Baltimore County, MD.
We also offer Maryland commercial auto insurance quotes throughout
the Old Line State.

Business Name:
Premises Address:
City:
State: MARYLAND     Zip Code:
Contact Name:
Phone #:    Ext #:
Fax:    Years in Business:
Email Address: (Required)
Federal Employer's ID #:
Description of Operations or SIC code:

Vehicle Information:

Vehicle     Year              Make              Model             Body Type
     1
     2
     3

Additional Vehicle Information:

                Miles          Cost                                     Where              Lienholder      Lienholder
Vehicle   Driven         New            VIN#               Garaged              Yes/No             Name
     1
     2
     3

Maryland Commercial Auto Insurance Coverage Information:

                      Liability                 Property                   Uninsured
Vehicle  Combined Limits          Damage               Combined Limits         Medical
     1
     2             SAME                       SAME                       SAME                   SAME
     3             SAME                       SAME                       SAME                   SAME

                   Collision         Comprehensive
Vehicle    Deductible           Deductible
     1
     2
     3

Maryland Driver Information:

                                  Drivers                          Date of                                              Drivers
Driver                       Name                               Birth                  Gender                 License #
     1
     2
     3

Is each employee's driving record accident & violation free during the past 5 years?
Driver
     1       If No, how many accidents?    How many violations?
     2       If No, how many accidents?    How many violations?
     3       If No, how many accidents?    How many violations?

Was any employee's driver's license suspended during the past 5 years?
Driver
     1
     2
     3

Recent Insurance Information:

Current Insurance Company:
Expiration Date: (mm/dd/yyyy)
Any losses past 3 years:
Description of losses, including amount paid on each accident:

Additional Information or Comments

Click on the "Submit Quote Information" button below to send
your Maryland Commercial Auto Insurance quote request.**

**Information received from this Maryland Commercial Auto Insurance quote request form
sent to Upper Chesapeake Insurance Agency, will be for our use only and will not be sold,
given to, or distributed to any other parties. A quote will be based on the commercial auto
insurance policy information provided and does not guarantee acceptance of the risk by us.
The precise coverage afforded is subject to meeting underwriting guidelines, and the terms,
conditions and exclusions of the policy as issued. By submitting this request you
acknowledge that this is neither an offer to insure nor a guarantee of insurance.
Completion of this form does not entitle your business to a Maryland Commercial Auto
Insurance Policy. We are licensed in Maryland and will not provide quotes for other states.