Mecury Business Auto

Mercury offers a business auto policy with flexible and affordable insurance plans to cover a wide variety of industries and vehicles.

Passenger Vehicles
Vans
SUV’s
Pick-Up’s/Light Trucks
Box Trucks
Flatbeds and Stake Trucks
Cherry Pickers under 60ft
Water Trucks
Refrigerator and Utility Trucks
Seasonal Snowplows
Flood Trucks
Hearses
Trailers

Artisan, Service and General Contractors
Agricultural
Food Trucks and Caterers
Manufacturers
Wholesalers
Retailers
Office
Sales/Marketing Professionals

Commercial Auto
Trailer
Liability Limits up to $1M
Comp & Collision
Medical and PIP
UM/UIM & UMPD
Towing
Hired/Non-owned
Drive Other Car
Broadened Form
Gap Coverage
Glass
Rental Reimbursement
Blanket Additional Insured
Blanket Waiver of Subrogation

States Available: AZ, FL, IL, NV, OK, TX, VA

US Map with selected states highlighted in dark blue

Submission Process

6 Vehicles or less: Complete Online Form

7+ Vehicles: email submissions to wholesale@sisinsure.com

Submission Requirements

ACORD 125, 127, and 137

SUBMIT ONLINE
Broker Name*
Agency Name*
Broker Phone:*
Broker Primary Email:*
Primary Name Insured:*
Entity Type:*
Type of Business:*

CREDIT INFORMATION
In connection with this quote or application for insurance, Mercury may review your credit report for rating or underwriting purposes, or obtain or use a credit-based insurance score based on the information contained in that credit report. We may use a third party, such as a consumer reporting agency, in connection with the development of your insurance score. If you believe the information in your credit report is inaccurate, you may request that your information be updated. On your request, Mercury will reevaluate you based on corrected credit information from a consumer reporting agency. To ensure report accuracy, please verify the following information BEFORE retrieving your Credit Score.
Credit application choice:*
Name*
First Last
Date of birth:*
MM slash DD slash YYYY
Social Security*
Credit holder address:*
Street Address City State ZIP Code
Enter credit level*

COVERAGE
Liability Limit:*
Uninsured Motorists Bodily Injury:*
Additional coverages
- Hired Auto Liability
- Broadening Endorsement (INCLUDES: Fellow Employee, Employees as Insureds, Employee Hired Autos, Blanket Additional Insured & Blanket Waiver of Subrogation Coverage)
- Hired Auto Physical Damage
- Non Owned Auto Liability
- Driver Other Car Coverage
- UMPD/CWC

DRIVER INFORMATION
Number of Covered Drivers*
DRIVER #1 INFORMATION
Driver #1 Name*
First Last
Driver #1 Date of Birth*
MM slash DD slash YYYY
Driver #1 License Number*
Driver #1 License State*
Date Driver #1 was added*
MM slash DD slash YYYY
Does Driver #1 have driving incidents on record?*
Driver #1 Incidents*
Source Violation Date Description Chargeable? (Yes-No)
DRIVER #2 INFORMATION
Driver #2 Name*
First Last
Driver #2 Date of Birth*
MM slash DD slash YYYY
Driver #2 License Number*
Driver #2 License State*
Date Driver #2 was added*
MM slash DD slash YYYY
Does Driver #2 have driving incidents on record?*
Driver #2 Incidents*
Source Violation Date Description Chargeable? (Yes-No)
DRIVER #3 INFORMATION
Driver #3 Name*
First Last
Driver #3 Date of Birth
MM slash DD slash YYYY
Driver #3 License Number*
Driver #3 License State*
Date Driver #3 was added*
MM slash DD slash YYYY
Does Driver #3 have driving incidents on record?*
Driver #3 Incidents*
Source Violation Date Description Chargeable? (Yes-No)
DRIVER #4 INFORMATION
Driver #4 Name*
First Last
Driver #4 Date of Birth*
MM slash DD slash YYYY
Driver #4 License Number*
Driver #4 License State*
Date Driver #4 was added*
MM slash DD slash YYYY
Does Driver #4 have driving incidents on record?*
Driver #4 Incidents*
Source Violation Date Description Chargeable? (Yes-No)
DRIVER #5 INFORMATION
Driver #5 Name*
First Last
Driver #5 Date of Birth*
MM slash DD slash YYYY
Driver #5 License Number*
Driver #5 License State*
Date Driver #5 was added*
MM slash DD slash YYYY
Does Driver #5 have driving incidents on record?*
Driver #5 Incidents*
Source Violation Date Description Chargeable? (Yes-No)
DRIVER #6 INFORMATION
Driver #6 Name*
First Last
Driver #6 Date of Birth*
MM slash DD slash YYYY
Driver #6 License Number*
Driver #6 License State*
Date Driver #6 was added*
MM slash DD slash YYYY
Does Driver #6 have driving incidents on record?*
Driver #6 Incidents*
Source Violation Date Description Chargeable? (Yes-No)
DRIVER #7 INFORMATION
Driver #7 Name*
First Last
Driver #7 Date of Birth*
MM slash DD slash YYYY
Driver #7 License Number*
Driver #7 License State*
Date Driver #7 was added*
MM slash DD slash YYYY
Does Driver #7 have driving incidents on record?*
Driver #7 Incidents*
Source Violation Date Description Chargeable? (Yes-No)
DRIVER #8 INFORMATION
Driver #8 Name*
First Last
Driver #8 Date of Birth*
MM slash DD slash YYYY
Driver #8 License Number*
Driver #8 License State*
Date Driver #8 was added*
MM slash DD slash YYYY
Does Driver #8 have driving incidents on record?*
Driver #8 Incidents*
Source Violation Date Description Chargeable? (Yes-No)

PAYMENT OPTIONS
Select payment choice:*
- Full Pay
- EFT 2 Pay
- EFT 4 Pay
- EFT 11 Pay
- Direct bill 2 Pay
- Direct bill 4 Pay
- Direct bill 10 Pay
Carrier provides a direct bill system to provide flexibility when paying your premium. You may select to pay in full or EFT and receive an additional discount. There is a nominal fee with each installment. Once bound, you will have the option of paying the carrier with check or credit card (MasterCard, American Express or VISA).
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SUBMIT ONLINE

INSURED/APPLICANT INFORMATION

CREDIT INFORMATION

COVERAGE

VEHICLE INFORMATION

VEHICLE #1 INFORMATION

VEHICLE #2 INFORMATION

VEHICLE #3 INFORMATION

VEHICLE #4 INFORMATION

VEHICLE #5 INFORMATION

VEHICLE #6 INFORMATION

DRIVER INFORMATION

DRIVER #1 INFORMATION

DRIVER #2 INFORMATION

DRIVER #3 INFORMATION

DRIVER #4 INFORMATION

DRIVER #5 INFORMATION

DRIVER #6 INFORMATION

DRIVER #7 INFORMATION

DRIVER #8 INFORMATION

PAYMENT OPTIONS

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Name	Relationship to Primary Named Insured

Source	Violation Date	Description	Chargeable? (Yes-No)

Source	Violation Date	Description	Chargeable? (Yes-No)

Source	Violation Date	Description	Chargeable? (Yes-No)