Anchor insurance, Inc.
30 Tremont Street • Duxbury, MA 02332
781-934-7114 local • 800-649-3000 toll free in MA. • 781-934-2717 fax

Massachusetts Commercial Auto Quote
We provide insurance coverage in Massachusetts only.
Sorry, other states not available.

In a hurry? Simply fax us a copy of your existing auto policy coverage page.
We can give you a quote from that!

1. Company Name

2. Contact Name

3. Mail Address

4. Street Address if different

5. City
 6. State
 7. Zip

8. Email

9. Work Phone / Ext.:

10. Fax

11. Best Time To Contact

12. Currently Insured? Yes NoIf No, proceed to Driver Information Question 15

13. If insured, list insurance carrier

14. Expiration Date (MM/DD/YY)

Driver Information

1 2 3 4
15. Last Name
16. First Name
17. Date of Birth (mm/dd/yy)
18. License Number

Vehicle Information

19. Number of vehicles to be quoted

1 2 3 4
20. Year (i.e. 1995)
21. Make
22. Model
23. Body Style
24. Gross Vehicle Weight (not required for cars)
25. Describe use of Vehicles
26. Snow Plowing Yes No Yes No Yes No Yes No
26a. If yes, do you plow for the state or town? Yes No Yes No Yes No Yes No
27. Radius of Work Miles Driven
28. Cost of Vehicle New
29. Does vehicle have any customized equipment? (example, lettering, signs, tool box etc.) Yes No Yes No Yes No Yes No
29a. If yes to #29, please list
30. Optional Bodily Injury (choose one)
31. Property Damage to Someone Else's Property
32. Medical Payments
33. Un-insured Motorist Coverage (choose one)
34. Underinsured Motorist Coverage (choose one)
35. Optional Comprehensive Deductible (fire/theft/vandalism/glass coverage)
36. Optional Collision Deductible
37. Optional Loss of Use (Car Rental) Yes No
 Yes No
 Yes No
 Yes No
38. Optional Towing Yes No
 Yes No
 Yes No
 Yes No

39. Questions and/or Comments

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Important Note: Quotes will be based on the information provided. It is only a rate calculation and is not binding in any way. A full application must be completed and signed by the named insured.