Commercial Auto Form

Nice to Meet You! Please let us know a little bit about your business.
Before we begin, quick question: will you be able to upload a picture of the drivers license for ALL drivers?*
- Yes
- No
- I will email them later to trucking@deerinsurance.com
Business Legal Name*
Do you have a D/B/A (Doing Business As) Name?*
- Yes
- No
D/B/A Name*
EIN (Employee Identification Number)*
Contact Person Name
First Last
Who is the President / CEO of the company?*
First Last
Involved in the daily operations of the business?*
- Yes
- No
Gender*
- Male
- Female
Date of Birth (MM/DD/YYYY)*
MM slash DD slash YYYY
Contact Phone Number*
Do you accept approve text messages?*
- Yes
- No
Contact Email
Mailing Address*
Number Street City State Zip Other

(House/Apt Number, Street, City, State, Zip)
Briefly describe your operations and the use of the vehicle*
Is the President / CEO the principal driver?*
- Yes
- No
Name of principal driver*
First Last
Date of Birth of Principal Driver*
MM slash DD slash YYYY
Marital Status*
- Married
- Single
Drivers License (DL) Information - Please provide if you are not able to send us a copy of the driver's license
DL State DL Number
Do you want to add additional drivers?*
- Yes
- No
Will you be emailing or uploading their driver's license?*
- Yes
- No
Please provide their full name, date of birth, and marital status
Full Name Date of Birth (MM/DD/YYYY) Married or Single

Year	Make	Model	Vin Number	In what year did you acquired it?

Year	Make	Model	In what year did you acquired it?

Scroll ⬇ DOWN ⬇ to complete the Form
Your Local & Trusted Insurance Agency
in Jacksonville, Florida

Number	Street	City	State	Zip	Other

Full Name	Date of Birth (MM/DD/YYYY)	Married or Single