Latino Tax and Express Services Inc.

Commercial Auto

Business State *

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Transportation Business Type *

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How is your business structured?

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Do you need federal or state USDOT filings? *

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USDOT Number

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Business Owner Age Group *

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Auto Liability Limit *

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General Liability Limit

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Trailer Interchange *

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Cargo Limit

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Reefer Breakdown *

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Farthest one-way distance any vehicle typically travels (90% or more of the time)

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Do any listed vehicles or the load require a hazardous material placard? *

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1st Tell us about your vehicle *

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1st Vehicle Value (choose only if you need Comprehensive and Collision)

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1st Truck Year *

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1st Truck Make *

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1st Truck Model

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1st - Do you have another Vehicle *

Yes

No

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2nd - Tell us about your vehicle

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2nd Vehicle Value (choose only if you need Comprehensive and Collision)

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2nd Truck Year

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2nd Truck Make

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2nd Truck Model

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2nd - Do you have another vehicle? *

Yes

No

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3rd - Tell us about your vehicle

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3rd Vehicle Value (choose only if you need Comprehensive and Collision)

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3rd Truck Year

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3rd Truck Make

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3rd Truck Model

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3rd - Do you have another vehicle? *

Yes

No

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4th - Tell us about your vehicle

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4th Vehicle Value (choose only if you need Comprehensive and Collision)

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4th Truck Year

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4th Truck Make

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4th Truck Model

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4th - Do you have another vehicle? *

Yes

No

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5th - Tell us about your vehicle

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5th Vehicle Value (choose only if you need Comprehensive and Collision)

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5th Truck Year

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5th Truck Make

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5th Truck Model

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1st - Tell us about your trailer

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1st Trailer Value (choose only if you need Comprehensive and Collision)

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1st Trailer Year

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1st Trailer Make

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1st Trailer Model

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1st - Do you have another trailer? *

Yes

No

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2nd - Tell us about your trailer

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2nd Trailer Value (choose only if you need Comprehensive and Collision)

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2nd Trailer Year

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2nd Trailer Make

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2nd Trailer Model

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2nd - Do you need another trailer? *

Yes

No

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3rd - Tell us about your trailer

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3rd Trailer Value (choose only if you need Comprehensive and Collision)

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3rd Trailer Year

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3rd Trailer Make

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3rd Trailer Model

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3rd - Do you have another trailer? *

Yes

No

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4th - Tell us about your trailer

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4th Trailer Value (choose only if you need Comprehensive and Collision)

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4th Trailer Year

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4th Trailer Make

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4th Trailer Model

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4th - Do you have another trailer? *

Yes

No

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5th - Tell us about your trailer

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5th Trailer Value (choose only if you need Comprehensive and Collision)

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5th Trailer Year

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5th Trailer Make

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5th Trailer Model

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1st Driver - First Name *

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1st Driver - Last Name *

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1st Driver - Accidents / Violations in the last 3 years

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1st Driver's License State

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1st Driver - Age Group *

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1st Driver - Do you have another driver? *

Yes

No

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2nd Driver - First Name

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2nd Driver - Last Name

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2nd Driver - Accidents / Violations in the last 3 years

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2nd Driver's License State

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2nd Driver - Age Group

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2nd Driver - Do you have another driver? *

Si

No

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3rd Driver - First Name

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3rd Driver - Last Name

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3rd Driver - Accidents / Violations in the last 3 years

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3rd Driver's License State

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3rd Driver - Age Group

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3rd Driver - Do you have another driver? *

Yes

No

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4th Driver - First Name

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4th Driver - Last Name

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4th Driver - Accidents / Violations in the last 3 years

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4th Driver's License State

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4th Driver - Age Group

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4th Driver - Do you have another driver? *

Yes

No

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5th Driver - First Name

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5th Driver - Last Name

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5th Driver - Accidents / Violations in the last 3 years

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5th Driver's License State

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5th Driver - Age Group

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Business Name

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Owner First Name *

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Owner Last Name *

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Owner Date of birth

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Address

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City

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State

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ZIP code

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Email (where quote will be sent) *

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Phone (where quote will be sent) *

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Text: (919) 797-0135

Fax: (919) 338-7652

Call: (919) 797-0135

Working hours

Monday: 8am - 6pm

Tuesday: 8am - 6pm

Wednesday: 8am - 6pm

Thursday: 8am - 6pm

Friday: 8am - 6pm

Sat - 8am - 3pm

Sun: Off

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