OWIS

Welcome to the One West Insurance Quick Quote system.  Use this form to submit the core information we need to provide you with a quote.  You are always welcome to call us during business hours,

ONE WEST INSURANCE SERVICES, LLC.

P.O Box 1588,3640 Sagunto St. #301, Santa Ynez CA 93460 Office: (805)688-8275 Toll Free: 877-500-WEST Fax: (805) 456-6654 License #OK07568

All coverages will be quoted at the limits listed below, unless otherwise requested. For expedited processing of your quote, please fill in all info as it pertains to you. If it does not apply, indicate with N/A.

Missing info will delay processing.

Auto Liability Medical Payments General Liability Cargo Non-Owned and Hired Physical Damage Uninsured/ Underinsured Motorist
$1,000.000 $5,000 $1,000,000 $100,000 $1,000,000 $1,000 deductible $60.000

Mailing Address & County:

Sole-Proprietor
Partnership
Corporation
LLC/LLP
Other
Loss runs available?: Yes No
Please List Commodities Hauled:
Driver Information - MVRs will be ordered & reviewed. Only acceptable drivers will be listed on policy.
Equipment(Tractor & Trailer)
I certify all the above information is true and we understand that if coverage is placed through a non- appointed carrier, a Broker Fee will be added to the policy, per Standard Broker Fee Agreement.