Company Name
Contact Name
Email Address
State
Phone Number
Fax Number
Brief desc. of business
Industry	Ground Transportation / Limo
	Sand & Gravel
	Waste
	Towing
	Other
Current Insurance Carrier
# of Vehicles in Fleet
Approx fleet value
Renewal Date

 

 

We will need the following information as we move forward

• Completed application signed & dated
• Drivers List - MVR's if available
• Vehicle List
• Three to Fives years loss runs from prior insurance carriers

 

Martens-Johnson Insurance Agency - Ga

2940 Horizon Park Dr Ste-B 
Suwanee, GA 30024

Toll Free: (877) 853.7372

Local: (678) 482.2254
Fax: (678) 377.1742