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Physical Damage Insurance for Personal Use of Company Vehicle(s)

As of the effective date of this policy, the day you enroll, if you are not 23 years of age (or within 90 days of your 23rd birthday) or older you will not be able to participate in this program. Open enrollment begins 4/30 - 5/31 of each year and is not prorated. Effective 6/1 of every year the premium you are charged is automatically prorated based on the date you enroll.

To obtain physical damage insurance for the personal use of company vehicles as indicated below please fill out the enrollment form below.

Coverage details are as followed:

  • Annual Premium (non prorated): $367.50
  • Comprehensive Coverage – U.S. $750 deductible
  • Collision Coverage – U.S. $750 deductible

Note: Coverage is not to exceed a maximum value of U.S. $40,000 per vehicle. Comprehensive physical damage as a result of a named storm is excluded.

Canadian Employees will be billed in U.S. $.
 


Employee / Driver Info
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Format is MM-DD-YYYY

Must be 23 years of age to enroll. If you are under the age of 23 please contact our office direct at 800-211-0317.

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Vehicle & Company Details
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valid phone format is required
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Billing Info
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Provided Information Agreement: *
I AGREE that the information that I provided is TRUE and ACCURATE.

You must AGREE to continue

Payment Agreement: *
I AGREE to submit payment for the coverage premium in the amount listed below in U.S. $.

You must AGREE to continue

Your credit card will be billed for the premium amount of $288.19

After you click Submit and Pay and upon successful transaction you will be presented with your certificate of insurance.

Thank you for your business!

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