Transcription of COMMERCIAL AUTOMOBILE APPLICATION
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Example: bankruptcy
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. Applicant is: Individual Partnership Corporation Other: Please provide the registered owner s driver license number, social security number, federal employer identifi-cation number or state customer number or Soundex number for all vehicles: 2.
CAS-APP-1 (1-04) Page 3 of 7 VEHICLE INFORMATION 27. Number of vehicles owned: Light Medium Heavy Extra Heavy Tractors Trailers Private Passenger Type
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