Online Application
Company Name
Contact Name
Address
City
State
Zip
Phone
Fax
E-mail
Business Description
Form of Business
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Sole Proprietor
Corporation
Limited Liability Company
Years in Business
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New Venture
1 year
2 years
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Number of Locations
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1
2
3
4
5
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10+
CONTACT IGTC
Phone:
(716) 856-6600
Fax:
(716) 856-6767
E-mail:
mpgagency@aol.com
One on One Service
Excellent Coverage; Fair Prices
Years Experience in Industry
Total Number of Owners,Officers & Directors
Annual Gross Sales (last 12 mo.)
Estimated Gross Sales (next 12 mo.)
Annual Gross Payroll (Excluding owners/officers/directors)
Total Number of Employees
Number of Full-time Employees
Number of Part-time Employees
Year
Make
Model
Cost New
Gross Vehicle Weight
Vehicle 1
Vehicle 2
Vehicle 3
Vehicle 4
Vehicle 5
Vehicle 6
Vehicle 7
Vehicle 8
Vehicle 9
Vehicle 10
