Transcription of COMMERCIAL AUTOMOBILE APPLICATION
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COMMERCIAL AUTOMOBILE APPLICATION
CAS-APP-1 (1-04) Page 1 of 7 Home Office: One Nationwide Plaza Columbus, Ohio 43215 Administrative Office: 8877 North Gainey Center Drive Scottsdale, Arizona 85258 1-800-423-7675 Fax (480) 483-6752 A STOCK COMPANY COMMERCIAL AUTOMOBILE APPLICATION Name of Applicant: Agent Name: D/B/A: Street Address: Address: Mailing Address: Agent No.: Phone Number: ( ) PROPOSED EFFECTIVE DATE: Website: From To 12:01 , Standard Time, at the address of the Applicant. PLEASE ANSWER ALL QUESTIONS IF THEY DO NOT APPLY, INDICATE NOT APPLICABLE. DESCRIPTION OF OPERATIONS 1.
CAS-APP-1 (1-04) Page 4 of 7 Unit No. Stated Amount or ACV Excluding Permanently Attached Equipment Value of Permanently Attached Special Equipment
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