Commercial Vehicle Rate Quote Request

We Serve:

Washington: 206-859-4894

Oregon: 503-445-4947

STOP! Our internet customers can go to the front of the line!

Vern Fonk Insurance gives our internet customers special attention by sending them to the front of the line. Please call during business hours: 9 am - 6 pm, Monday through Friday and 9 am - 2 pm on Saturday for immediate assistance on your business insurance needs.

Washington State clients, please call our Washington Commercial Department at 206-859-4894. Oregon clients, please call our Oregon Commercial Department at 503-445-4947.

Internet customers only!

Please fill out the form below and we will contact you with an insurance quote and answer any questions you have. Required fields are marked with a * , however to receive the most accurate quote we prefer that you answer all the questions.

Tell Us About Your Business
*Contract Hauler?	Yes No
*PUC Filing?	Yes No
*Business contact person:
*Contact Phone:	– ext.
Cell Phone:	– ext.
*Business Address:
*City:
*State:
*Zip code:
*Email:
How many years have you been licensed?	/yrs
Current Insurance Company (if applicable):
How long have you been with your current provider:	/yrs /mo

How did you hear about us?
*How did you hear about us?

Tell Us About Your Spouse (if applicable)
*First Name:
Middle Initial:
*Last Name:
*Gender:
*Date of Birth (mm/dd/yyyy):	/ /
Occupation:
*How many years have you been licensed?	/yrs
Current Insurance Company (if applicable):
How long has your spouse been with his/her current provider:	/yrs /mo

Additional Drivers
If you are insuring drivers other than yourself including your spouse, please fill out their information below. If you need to insure more than 4 drivers, please make note in the comments area at the bottom of the form.
First Name	Date Of Birth	SR22?
	/ /	Yes No
	/ /	Yes No
	/ /	Yes No
	/ /	Yes No

Driving Violations
Please specify violations for the drivers above. If there are more than 8 violations, please make note in the comments area at the bottom of the form.
Driver's Name	Violation	Date of Violation
		/ /
		/ /
		/ /
		/ /
		/ /
		/ /
		/ /
		/ /
If you have more than 4 moving violations, you are not eligible for our commercial vehicle insurance product.

Need A SR-22?
If you need an SR-22 filing, please indicate the State here.

Tell Us About Your Vehicles
If you have more than 3 vehicles, please make note in the comments* area at the bottom of the form.
Vehicle One
*Year:
*Make:
*Model:
*Gross Vehicle Weight:
4x4:	Yes No
Do you have a loan on this car?	Yes No
*Comprehensive (DEDUCTIBLE):
*Collision (DEDUCTIBLE):
Vehicle Two
Year:
Make:
Model:
*Gross Vehicle Weight:
4x4:	Yes No
Do you have a loan on this car?	Yes No
*Comprehensive (DEDUCTIBLE):
*Collision (DEDUCTIBLE):
Vehicle Three
Year:
Make:
Model:
*Gross Vehicle Weight:
4x4:	Yes No
Do you have a loan on this car?	Yes No
*Comprehensive (DEDUCTIBLE):
*Collision (DEDUCTIBLE):