(D & D Business Services - Girard, PA) Rate Quote


	Services		Rate Quote		IFTA		Audits		About Us

D & D Business Services
8473 W Peach Street
Girard, PA 16417
Ph. (814) 774-2550
Fax (814) 774-0818

		First Name *		Middle Initial		Last Name *

		Requested Carrier Name

		Street Address

		City		State		Zip Code

		Mailing Address if Different from Above (Street or PO Box)

		City		State		Zip Code

		Phone *		Fax		Cell Phone

		Insurance Agent Name		Agent Contact		Agent Phone Number

Will You Operate As An:

Individual

Partnership

Corporation

		SS #		EIN #		DOB

		Drivers License #		State Issued

		Truck Info (Fax a clear copy of registration card if possible)

		Year		Make		VIN#

		Unladen Weight		Registered Gross Weight

What states are you registered to operate in?

* Required to submit this form

D & D Business Services
(814) 774-2550
djstruchen@dndbus.com

Services | Rate Quote | IFTA | Audits | About Us