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Step
1
of 5
ZIP Code
*
Please choose what best describes your business.
*
Please Select
Contracting & Construction Businesses
On-Demand Services (Uber, Lyft, Amazon, etc.)
Other Common Businesses
Social Services & Non-Profit Organizations
Transportation, Trucking, and Towing Businesses
Let’s get a little more detail. Please pick what kind of contracting or construction business you have.
*
Please Select
Carpentry
Concrete Work
Drywall, Plastering, Acoustical, and Insulation Work
Electrical, Plumbing, HVAC, Cabling, A/V & Alarm Installation
Excavating
Floor Laying
General Contractors - Other Than Single Family Houses
General Contractors - Single Family Houses
Masonry & Stone Work
Other Special Trade Contractors (Including Handymen)
Painting & Wallpaper Hanging
Rideshare/On Demand/Uber/Lyft/Passenger/TNC/Amazon
Roofing, Siding, and Sheet Metal Work
Sand/Gravel/Rock/Stone
Tile, Terrazzo, Marble & Mosaic Work
Welding
Not Listed
Let’s get a little more detail. Please pick what kind of on-demand services (Uber, Lyft, Amazon, etc.) you do.
*
Please Select
Contracting & Construction Services
Food & Catering Services
General Task/Help Services
Homecare & Cleaning Services
Laundry Services
On Demand Delivery
Other On-Demand Services
Rideshare/On Demand/Uber/Lyft/Passenger/TNC/Amazon
Storage Services
Not Listed
Let’s get a little more detail. Please pick an option that fits your business type.
*
Please Select
Automotive Repair Services/Mobile Mechanics
Carpet/Upholstery/Furniture Cleaning
Cleaning Services (Homes or Offices)
Computer Consulting & Repair Services
Fire/Rescue/Law Enforcement/Other Public Services
Furniture Reupholstery and Repair
Home Inspections
Installations- Cable/Security/Sprinklers/Gas Lines/Etc.
Insurance Sales/Brokers/Agents
Landscaping/Lawn & Tree Services
Locksmiths/Horseshoeing/Other Repair Services
Mobile Restaurants/Concessions/Vendors
Newspapers, Mail, and Magazines
Pest Control/Disinfecting/Restroom Cleaning Services
Pet Services- Grooming/Shelters/Kennels
Cleaning Services
Real Estate- Sales/Management/Appraisals/Brokers
Religious Organizations
Restaurants/Caterers/Eating Places
Rideshare/On Demand/Uber/Lyft/Passenger/TNC/Amazon
Sand/Gravel/Rock/Stone
Vending Machine Services
Wholesale & Manufacturing Businesses
Not Listed
Let’s get a little more detail. Please pick an option that fits your social services or non-profit organizations business.
*
Please Select
Adoption/Foster Care/Child Relocation Agencies
Adult Day Care Centers
Child Care Centers
Civic, Social, and Fraternal Associations
Counseling Centers- Drug/Alcohol/Etc.
Counseling Centers- Marriage/Family/Etc.
Hotline Centers
Emergency Shelters & Disaster Services
Fire/Rescue/Law Enforcement/Other Public Services
Fundraising Organizations
Halfway House/Criminal or Offender Rehabilitation
Halfway House/Drug Rehabilitation Center
Head Start/Preschool Centers
Hospice/Home-Health Services
Job Training/Vocation Centers/Employment Counseling Services
Labor Unions And Similar Labor Organizations
Outreach Programs/Community Centers
Political Organizations
Religious Organizations
Residential Care/Group Home
Not Listed
Let’s get a little more detail. Please pick an option that fits your transportation, trucking, or towing business.
*
Please Select
Airport Transportation
Chartered Buses- Local Only
Chartered Buses- Other Than Local
City & Suburban Local Transportation Services
Courier Services
Newspapers, Mail, and Magazines
Religious Organizations
Repossession/Recovery Services
Rideshare/On Demand/Uber/Lyft/Passenger/TNC/Amazon
Salvage/Scrap Metal Businesses
School Buses
Taxicab Services
Towing/Wrecker Services
Trucking- Local Only
Trucking- Other Than Local
Vanpools/Limousine Rentals/Sightseeing Services
Wholesale and Manufacturing Businesses
Not Listed
Which of the following companies do you drive for (select all that apply)?
*
Uber
Lyft
ZipCar
Other transportation network company (TNC) not listed
I do not drive for an on-demand or TNC
How long have you driven for them?
*
I haven't started yet
Less than 3 months
3 to 6 months
6 to 12 months
1-2 years
More than 2 years
Is ridesharing your main source of income?
*
Yes
No
Type of Business
*
Please Select
Construction
Farming, Agriculture, Forestry, And Fishing
Finance, Insurance, And Real Estate
Manufacturing
Mining
Public Administration
Retail Trade
Services
Transportation, Communications, Electric, Gas, And Sanitary Services
Wholesale Trade
Industry Type
*
Please Select
Building Construction General Contractors And Operative Builders
Construction Special Trade Contractors
Heavy Construction Other Than Building Construction Contractors
Industry
*
Please Select
Industrial Buildings & Warehouses
Nonresidential Construction
Operative Builders
Residential Construction
Single Family Housing Construction
Industry
*
Please Select
Carpentering
Concrete Work
Electrical Work
Excavating & Foundation Work
Floor Laying, Floor Work
Glass, Glazing Work
Installation, Building Equipment
Masonry, Other Stonework
Painting, Paper Hanging & Decorating
Plastering, Drywall, Insulation
Plumbing, Heating(No Elec) & Air Cond.
Roofing, Sheet Metal Work
Special Trade Contractors
Structural Steel Erection
Terrazzo, Tile, Marble & Mosaic Work
Water Well Drilling
Wrecking, Demolition Work
Industry
*
Please Select
Bridge, Tunnel & Elevated Highway Const.
Heavy Construction
Highway & Street Construction
Water, Sewer & Utility Construction
Industry Type
*
Please Select
Farming & Agricultural Production: Crops
Farming & Agriculture Production: Livestock and Animal Specialties
Fishing, hunting, and trapping
Forestry
Other Farming & Agricultural Services
Industry
*
Please Select
Animal Specialty Services
Cotton Ginning
Crop Harvesting
Crop Planting & Protecting
Crop Preparation Services For Market
Farm Labor Contractor
Farm Management Services
Landscape Counseling
Lawn & Garden Services
Livestock Services
Shrub & Tree Services
Soil Preparation Services
Veterinarian Services, Farm Stock
Veterinarian Services, Specialties
Industry
*
Please Select
Berry Crops
Cash Grains
Citrus Fruits
Corn
Cotton
Deciduous Tree Fruits
Farm Crops, General
Field Crops Except Cash Grains
Food Crops Grown Under Cover
Fruits & Tree Nuts
Grapes
Ornamental Nursery Products
Potatoes, Irish
Rice
Soybeans
Sugar Crops
Tobacco
Tree Nuts
Vegetables & Melons
Wheat
Industry
*
Please Select
Animal Aquaculture
Animal Specialties
Beef Cattle Except Feedlots
Beef Cattle Feedlots
Chicken Eggs
Chickens, Broiler & Fryer & Roaster
Dairy Farms
Farms, Primarily Livestock
Fur-Bearing Animals & Rabbits
General Livestock, Except Dairy, Poultry
Hogs
Horses & Other Equine
Poultry & Eggs
Poultry Hatcheries
Sheep & Goats
Turkeys & Turkey Eggs
Industry
*
Please Select
Finfish
Fish Hatcheries & Preserves
Hunting & Trapping Game Propagation
Marine Products, Misc.
Shellfish
Industry
*
Please Select
Forest Products
Forestry Services
Timber Tracts
Industry Type
*
Please Select
Depository Institutions
Holding And Other Investment Offices
Insurance Agents, Brokers, And Service
Insurance Carriers
Non-depository Credit Institutions
Real Estate
Security And Commodity Brokers, Dealers, Exchanges, And Services
Industry
*
Please Select
Central Reserve Depository
Commercial Banks
Federal Credit Unions
Federal Reserve Banks
Federal Savings Institutions
Foreign Bank And Branches And Agencies
Foreign Trade And International Banks
Functions Related To Deposit Banking
National Commercial Banks
Nondeposit Trust Facilities
Savings Institutions, Except Federal
State Commercial Banks
State Credit Unions
Industry
*
Please Select
Bank Holding Companies
Educational, Religious & Charitable Trusts
Holding Companies
Investment Offices
Investors
Management Investment Offices, Open-End
Oil Royalty Traders
Patent Owners & Lessors
Realty Mortgage Investment Trusts
Trusts, Except Educational, Rel & Charitable
Industry
*
Please Select
Insurance Agents, Brokers & Service
Industry
*
Please Select
Accident & Health Insurance
Fire, Marine & Casualty Insurance
Hospital & Medical Service Plans
Insurance Carriers, Misc
Life Insurance
Pension, Health & Welfare Funds
Surety Insurance
Title Insurance
Industry
*
Please Select
Federal And Federally-Sponsored Credit
Loan Brokers
Miscellaneous Business Credit Institutions
Mortgage Bankers & Loan Correspondents
Personal Credit Institutions
Short Term Business Credit Institutions
Industry
*
Please Select
Agents, Managers--Real Estate
Apartment Building & Res. Hotel Operations
Building Operators, Nonresidential
Cemetery Subdivision & Development
Dwelling Oper. (Less Than 5 Housing Units)
Railroad Property Lessors
Real Property Lessors
Residential Mobile Homesites, Operators Of
Subdividers, Developers, Except Cemeteries
Title Abstract Offices
Industry
*
Please Select
Commodity Contracts Brokers & Dealers
Investment Advice
Securities Brokers, Dealers & Flotation Cos.
Security & Commodity Exchanges
Security And Commodity Services
Industry Type
*
Please Select
Apparel And Other Finished Products Made From Fabrics And Similar Materials
Chemicals And Allied Products
Electronic And Other Electrical Equipment And Components, Except Computer Equipment
Fabricated Metal Products, Except Machinery And Transportation Equipment
Food And Kindred Products
Furniture And Fixtures
Industrial And Commercial Machinery And Computer Equipment
Leather And Leather Products
Lumber And Wood Products, Except Furniture
Measuring, Analyzing, And Controlling Instruments; Photographic, Medical And Optical Goods; Watches And Clocks
Miscellaneous Manufacturing Industries
Paper And Allied Products
Petroleum Refining And Related Industries
Primary Metal Industries
Printing, Publishing, And Allied Industries
Rubber And Miscellaneous Plastics Products
Stone, Clay, Glass, And Concrete Products
Textile Mill Products
Tobacco Products
Transportation Equipment
Next
Business Info
Business Owner Name
*
First
Last
Company Name
*
Phone
*
Email Address
*
Address
*
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Are all vehicles regularly parked overnight at the above address?
*
Yes
No
Please Input Garaging Address
*
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Do you have a Global Guard insurance policy?
*
Yes
No
Global Guard Policy Number
*
How long have you been a Global Guard policyholder?
*
Less Than 1 Year
1-2 Years
2-3 Years
3-4 Years
4-5 Years
5-6 Years
6-7 Years
7-8 Years
8-9 Years
9-10 Years
10-15 Years
15-20 Years
20-25 Years
More Than 25 Years
Please Select
Business Ownership Type
*
Individual/Sole Proprietorship
Corporation
Limited Liability Company
Non-profit
Partnership
Trust
Other
Please Select
Business Name
*
How long have you been in your current business?
*
Less Than 1 Year
1-2 Years
2-3 Years
3-4 Years
4-5 Years
5-6 Years
6-7 Years
7-8 Years
8-9 Years
9-10 Years
10-15 Years
15-20 Years
20-25 Years
More Than 25 Years
Do you currently have auto insurance?
*
Yes, I currently have commercial auto insurance.
Yes, I currently have personal auto insurance.
Yes, I currently have both commercial & personal auto insurance.
No, My auto insurance ran out (not driving)
No, I haven't needed auto insurance.
No, I was deployed
No, I am currently driving without insurance.
How long have you been with your current auto commercial insurance company??
*
How long have you been with your current auto commercial insurance company?
*
How long have you been with your current auto commercial insurance company?
*
When did your most recent commercial auto insurance end?
*
Why haven't you needed auto insurance?
*
Did you have insurance prior to being deployed?
*
Yes
No
Next
What year is your vehicle?
*
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1998
1997
Make
*
Acura
Alfa Romeo
Audi
BMW
Bentley
Buick
Cadillac
Chevrolet
Chrysler
Dodge
Fiat
Ford
GMC
Genesis
Honda
Hyundai
Infiniti
Jaguar
Jeep
Kia
Land Rover
Lexus
Lincoln
Lotus
Maserati
Mazda
Mercedes-Benz
Mercury
Mini
Mitsubishi
Nikola
Nissan
Polestar
Pontiac
Porsche
Ram
Rivian
Rolls-Royce
Saab
Saturn
Scion
Smart
Subaru
Suzuki
Tesla
Toyota
Volkswagen
Volvo
Wabash
Walker
Western Star
Western Trailers
Wilson
Vehicle Not Listed
Trailer Not Listed
Model
*
Who is registered owner of the vehicle?
*
First
Last
Registered State
*
Vehicle Ownership
*
Owned
Leased
Financed
Has the vehicle been customized or modified in any way?
*
Yes
No
How much are your customizations or modifications worth? Please put a dollar amount.
*
What is the main purpose of this vehicle?
*
Personal Use
Personal & Business Use
Business Use
How many miles do you regularly travel from where the vehicle is garaged (radius of operation?)
*
100 Miles
300 Miles
500 Miles
Unlimited
Do you use this vehicle mainly to carry tools or equipment to job sites for your work?
*
Yes
No
Who is the main driver of this vehicle?
*
Owner(s) of the company
Employees of the company
Other (non employees, volunteers, etc)
Do you need to add another commercial vehicle or trailer?
*
Yes
No
What year is your second vehicle?
*
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1998
1997
Make
*
Acura
Alfa Romeo
Audi
BMW
Bentley
Buick
Cadillac
Chevrolet
Chrysler
Dodge
Fiat
Ford
GMC
Genesis
Honda
Hyundai
Infiniti
Jaguar
Jeep
Kia
Land Rover
Lexus
Lincoln
Lotus
Maserati
Mazda
Mercedes-Benz
Mercury
Mini
Mitsubishi
Nikola
Nissan
Polestar
Pontiac
Porsche
Ram
Rivian
Rolls-Royce
Saab
Saturn
Scion
Smart
Subaru
Suzuki
Tesla
Toyota
Volkswagen
Volvo
Wabash
Walker
Western Star
Western Trailers
Wilson
Vehicle Not Listed
Trailer Not Listed
Model
*
Who is registered owner of the second vehicle?
*
First
Last
Registered State
*
Vehicle Ownership
*
Owned
Leased
Financed
Has the second vehicle been customized or modified in any way?
*
Yes
No
How much are your customizations or modifications worth? Please put a dollar amount.
*
Is the second vehicle only used for commuting to work or school? (Never used to travel to job sites or for other business uses.)
*
Yes
No
How many miles do you regularly travel from where the vehicle is garaged (radius of operation)?
*
Do you use this vehicle mainly to carry tools or equipment to job sites for your work?
*
Yes
No
Who is the main driver of this vehicle?
*
Owner(s)
Employees of the business
Other (non employees, volunteers, etc)
Next
Name
*
First
Last
Date of Birth
*
MM
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26
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31
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YYYY
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
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1984
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1981
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1932
1931
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1928
1927
1926
1925
1924
1923
1922
1921
1920
What is this driver's relationship to the business?
*
Owner
Authorized Representative
Employee
Other
Has this driver been licensed for at least 5 years?
*
Yes
No
Employee Information
How many employees do you have, including part time employees?
*
None
1 Employee
2-3 Employees
4-5 Employees
6-10 Employees
11-20 Employees
20+ Employees
(Do not include yourself or partners.)
Does your business do employee drug testing and or criminal background checks?
*
Yes
No
We need some info on driver training. As a business, do you offer employee driver training or some sort of accident prevention programs?
*
Yes
No
Do you carry worker’s compensation insurance coverage for your drivers?
*
Yes, All Drivers
Some Drivers
No Drivers
How many people will drive your vehicles?
*
1 Person
2 People
3 People
4 People
5 People
6 People
7 People
8 People
9 People
10+ People
Please include yourself, employees, and other household members.
Do you need to add any drivers? Please add all owners as drivers.
*
Yes
No
Name
*
First
Last
Name
*
First
Last
Name
*
First
Last
Next
Has any driver had any of the following?
*
Accidents (regardless of fault) within the last 3 years
Traffic convictions within the last 3 years
Traffic convictions for DUI/DWI, reckless driving, or driving on a suspended license within the last 5 years
NONE
Coverage Information
What bodily injury limits do you currently have on your vehicle insurance?
*
State Minimum
$25,000/$50,000 or $50,000 CSL
$50,000/$100,000
$100,000/$100,000 or $100,000 CSL
$100,000/$300,000
$300,000/$300,000 or $300,000 CSL
$250,000/$500,000
$500,000/$500,000 or $500,000 CSL
$750,000/$750,000 or $750,000 CSL
$1,000,000/$1,000,000 or $1,000,000 CSL
I do not currently have insurance
Comment
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