CNI


Consolidated National Insurers, Inc - Professional Insurance Management

                 

Used Car Program:

Fill out the form below and submit via email, or print this page and fill out the form, then fax or mail it to us. Our agents will be in touch!

First Name: Last Name:
Business Name:
Doing Business As:
Location:
State: Zip:
Phone Number:       Fax Number:       Email Address:
Effective Date:
Current Insurance Co.:
Current Annual Premium: $
Payroll: $
Property Coverage
Building Limit: $    Content: $ Business Income: $    Deductible: $
Other Coverages:
Glass:     Signs: $     Vehicle Damage: $
Equipment Breakdown:     Gasoline: $     Money & Sec.: $
Liability Coverage
Liability Limit: $       Garage Keepers:       Fire Legal Liability (Max $300,000): $
Auto Liability
Vehicle Information:
Year:       Make:       Model:
Comp.(ded.): $       Coll.(ded.): $       Cost New: $
Garage Location:



                 



CNI | 925 Harvest Drive | PO Box 1057 | Blue Bell, PA 19422
215-654-0777 | 800-562-3073 | FAX: 215-654-0383