- Additional Information (NOT required, but this information will help us give you the most accurate quote)
Please list the names of additional insureds.
Please list commodities hauled with % of each.
List all claims you have had in the last three years. Provide as much detail as you can including amounts paid.
If we provide a quote from the information obtained through this website, it will be for the purpose of providing you with a helpful indication of our basic terms and price. Limits of liability, additional coverage options and deductibles will be discussed with you by the agent responding to this inquiry. Any quote offered will be subject to satisfactory answers to additional questions asked by this agent during the underwriting process. Coverage cannot be bound from this website even if a quote is provided. Eastern Atlantic Insurance Company reserves its right to decline any request for a quote or withdraw any quote previously issued. If we issue a policy based on information you provided that proves to be fraudulent in nature Eastern Atlantic Insurance Company will respond accordingly subject to the laws governing fraud and / or misrepresentation in effect in the state in which your business is domiciled. BY SUBMITTING THIS REQUEST YOU AGREE TO THESE TERMS AND CONDITIONS.