Ararat Insurance Services Insurance in Seatac Washington

Customer Name *

DBA

Garaging Address *

Phone *

Email *

Cancelled/Non-Renewed?

Type of Operation

Fare Box/Meter : Yes/No

Unscheduled Passengers: Yes/No

Do you charge by the: Hour, Trip, Miles

Do you use transportation network companies, ridesharing apps such as Uber, Lyft, Sidecar, Wingz?

If Yes, how many trips per day do you provide through such service? What percentage of your work is it?

Year *

Make *

Model *

VIN *

Stated Value: *

Seating Capacity

Stretch / Lenght

First and Last Name *

Date of Birth *

Drivers License # *

Date of Hire

Yrs of Experience *

# of Accidents or Violations

Auto Liability *

UM / UIM

Personal Injury Protection (PIP)

Medical Payments

Comprehensive: (Deductible)

Collision: (Deductible)

Radio Buttons

Hired Auto

Non-Owned Auto

Accidents *

YES

NO

Please attach driving records and loss runs for the past 3 years; File Upload

Maximum upload size: 67.11MB