National Interstate Insurance

Fast Track Questionnaire

Insurance Choices > Transportation > Passenger > Fast Track Quote

* Required Fields

Contact Information

Company Name *

DBA

Mailing Address (Address, City, State, Zip)

Garaging Address (Address, City, State, Zip)

Phone *

Fax

Contact Person *

Contact Person Title *

Contact Person Email Address *

Company Website

Company Operations

Type of Operation

Charter

Transit

School

Limousine

Paratransit

Other

If other, enter type here:

Top Destinations Traveled To

City & State

Percentage of Travel

City & State

Percentage of Travel

City & State

Percentage of Travel

City & State

Percentage of Travel

City & State

Percentage of Travel

Number of Years in Business

Total Number of Vehicles Operated

Current Insurance And Agent Information

Current Insurance Company Name *

Current Policy Expiration Date

Agency / Broker Name

Address

Phone

Agent / Broker Contact Name

Agent / Broker Email Address

Would you like a National Interstate approved Agent/Broker to contact you?

Yes

Providing your information above does not obligate National Interstate to provide a quote or a policy to you. This is not a complete application. Your information may be shared with third parties in order for us to respond appropriately. Please see our Privacy Policy for more information on our privacy practices.

Coverage Options include:

Automobile Liability
General Liability
Physical Damage
Garage Liability
Workers' Compensation (captives programs only)
Excess Liability Available with limits up to $20,000,000

If you’re interested in learning about creative passenger insurance solutions, contact us at marketing@natl.com.

Application