Request For Boat Quote
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1RFQ
Thum Insurance Agency, L.L.C.
3140 3 Mile Rd NE
Grand Rapids, MI 49525-3165
Request For Quote
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Phone: 800-866-0777 - Fax: 616-957-1204
Company Code: ___________________________ Company Name: _______________________________________
Address: _______________________________________________________________________________________
Business Phone: (____) _____-_______ Ext: ___
Cell Phone: (____) _____-_______
Fax: ( ____) _____-_______
Contact: _________________________________ Email: _______________________________________________
Buyer Information: Name: _____________________________ Date of Birth:________ Gender: _____M _____ F
Martial Status: __ M __ S __ W Driver’s License #: __________________________ License State: ___________
Number of Violations: ____ Minor
___ Major
___ At Fault Accidents
Spouse Name: _____________________________________ Date of Birth: ____________ Gender: ____M ____F
Driver’s License #: _______________________________ License State: __________
Number of Violations: ____ Minor ____ Major ____ At Fault Accidents
Mailing Address: ________________________________________________________________________________
Registration Address (if different than Mailing):
______________________________________________________________________________________________
Garaging Address (if different than Mailing):
______________________________________________________________________________________________
Home Phone: (____) _______-_________
Cell Phone: ( ____) ______ -________ Fax: (____) ______-__________
Best Time To Call: ___:___ am / pm
Email: _________________________________________________________
Trailer Information:
Purchase Date: ____/____/____ Purchase Price: $______________ Length: _______
GVWR: ____________
Year: _______ Make: _____________ Model: _______________ VIN: ___________________________________
Personal Use: ____ Business Use: _____ Business Name: ______________________________________________
Business Address: ______________________________________________________________________________
___ Horse/Animal Trailer with Living Quarters
___ Horse/Animal Trailer without Living Quarters
___ Cargo Trailer
___ Car Hauler Enclosed ___ Open Trailer
___ Other - Please List: ______________________
Lien Holder Name: ______________________________________________________________________________
Lien Holder Address:_____________________________________________________________________________
Phone: (____) _____-______ Fax: (____) _____-______ Email: _________________________________________
FOR FAST SERVICE: EMAIL THIS FORM
AND
EMAIL THE TRAILER SALES AGREEMENT TO:
or
Print and Fax this Form and the Trailer Sales Agreement to: 616-957-1204
Print Form
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