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Northamerican transportation association inc |
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Phone 562 508-4880 Website www.ntassoc.com |
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ACROSS THE STREET… AND ACROSS THE NATION!! |
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1800-207-5178 |
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Sales |
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1800 207 5178 |
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562 508-0880 |
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Insurance quote request |
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Please complete and fax it back to us, one of our representatives will contact you shortly. Call Back Number: _______________________ Email:______________________ 1.- Legal Name__________________________________2.- DBA______________________________________ 3.-USDOT Number_____________________4.-MC number_________________________ 5.-Tax ID number________________________ Desired coverage 5.-Dates: From ____________________To______________________ 6.-General Liability:_$___________________________ 7.- Auto Liability:_$______________________ 8.- Physical Damage_$__________________________9.-Cargo_$_____________________________ Truck Info: 1.- Make and Mode _____________________________________Vin # _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 2.- Make and Model ____________________________________Vin # _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 3.- Make and Model ____________________________________Vin # _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Trailer Info: 1.- Make and Model ____________________________________Vin # _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 2.- Make and Model ____________________________________Vin # _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 3.- Make and Model ____________________________________Vin # _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Driver’s Info: Name _____________________D.O.B. ___________________Driver License #____________________ Name _____________________D.O.B. ___________________Driver License #____________________ Name _____________________D.O.B ____________________Driver License #____________________ Name _____________________D.O.B ____________________Driver License #____________________ 48 states: Yes________ No________ Miles One Way________________________________ States:_________________________________________________________________________ We will contact you shortly. Feel
free to give us a call at 562-508-4880 |
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