14887 Hwy 105 W, Suite 102
Montgomery, TX 77316

1-866-TEXAS-45
(1-866-839-2745)

Our Texas Insurance Policies & Coverages

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Car Wash, Body Shops & Gas Stations

Please fill out the attached forms that apply to your insurance quote request and fax the information back to us.

Please Fax Completed Forms To 936-309-0050

Our agency may still need to contact you for some additional information, so be sure to provide your contact information

(name, phone number and e-mail address).

Thanks in advance.

Use with the Acord Application

Insurance Applications

12
Acord Application - Service Station
Use your completed Acord Application along with the AMC Service Station Acord Supplemental Application.
11
   

Insurance Supplementals

10

Full Service Car Wash Supplemental

9 Acord Supplemental Application
8

Body Shop Supplemental Application

7

LPG Supplemental Application

6

Private Passenger Auto Supplemental Application

5

Tow Truck Supplemental

4

Truck Stop Supplemental Application

 

Insurance Forms

3

Stonington Rejection Form

2

Stonington Fraud Statement

1

Stonington Service Station Broad Form Summary

Please Fax Completed Forms To 936-309-0050