WBW Insurance Agency, Inc. Bill West, Gurnee WBW Insurance Agency, Inc. Bill West, Gurnee WBW Insurance Agency, Inc. Bill West, Gurnee
Bill West - Illinois and Wisconsin Insurance Agent

Bill West - Wm B West Insurance Agency, Inc.
Illinois & Wisconsin (224) 538-2006
WBW Insurance Agency, Inc. Bill West, Gurnee
Request an Insurance Quote for:

Commercial Vehicle Insurance
Contact Information
We can only underwrite businesses and residents located in Illinois and Wisconsin.
 
Company Name
Company Street Address
City
State
 Zip
 
Contact Name
Phone
Fax
Email
 
Company Insurance Information   Business Information
 
Are you currently insured?
Yes   No
If "yes" list the name of the carrier and number of years continuous.
Please list claims and amounts paid
 
Years in Business
Business Type
(corporation, proprietorship, etc.)
How are Vehicles Used?
 
Driver Information
 
How many drivers do you need to insure?
If it is more than 2 we will contact you for additional driver information.
DRIVER #1:
Name
Birthdate:
Sex: Male Female
# of Years US Driver's License
# and Type of Accidents within last 3 years:
# and Type of Minor Citations within last 3 years:
# and Type of Major Citations within last 3 years:
How many miles is one-way daily commute?
Does driver need an SR22 Filing? Yes No
 
DRIVER #2:
Name
Birthdate:
Sex: Male Female
# of Years US Driver's License
# and Type of Accidents within last 3 years:
# and Type of Minor Citations within last 3 years:
# and Type of Major Citations within last 3 years:
How many miles is one-way daily commute?
Does driver need an SR22 Filing? Yes No
 
Vehicle Information
 
How many commercial vehicles do you need to insure?
If it is more than 2 we will contact you for additional vehicle information.
COMMERCIAL VEHICLE #1:
Type of Vehicle (truck, car, bobcat, etc.):
Make and Model:
Year of Vehicle:
Length in Feet:
Radius of Operation:
Value:
List any special equipment such as a tool box and its value:
 
COVERAGE FOR VEHICLE #1:
Limits of Liability:
$15/30 BI/ 10 PD $25/50 BI/ 15 PD $50/100 BI/ 25 PD
$100/300 BI/ 50 PD $250/500 BI/ 100 PD $1 Million
Comprehensive Collision:
No Coverage $250 Deductible
$500 Deductible $1000 Deductible
Medical Coverage?
yes no
Uninsured Motorists?
yes no
 
COMMERCIAL VEHICLE #2:
Type of Vehicle (truck, car, bobcat, etc.):
Make and Model:
Year of Vehicle:
Length in Feet:
Radius of Operation:
Value:
List any special equipment such as a tool box and its value:
 
COVERAGE FOR VEHICLE #2:
Limits of Liability:
$15/30 BI/ 10 PD $25/50 BI/ 15 PD $50/100 BI/ 25 PD
$100/300 BI/ 50 PD $250/500 BI/ 100 PD $1 Million
Comprehensive Collision:
No Coverage $250 Deductible
$500 Deductible $1000 Deductible
Medical Coverage?
yes no
Uninsured Motorists?
yes no
 

 
 
The information on these pages is intended to be accurate at the time posted. It is for general informational purposes only. Because of the nature of this information, it may not be applicable in your area or current at the time you read it. Please see your agent or review the policy contract for detailed information you can rely on. The information on this site may change without prior notice.
 
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