Martens-Johnson Insurance Agency - Georgia
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Please fill out the form below.

Company Name
Contact Name
Email Address
State
Phone Number
Fax Number
Brief desc. of business
IndustryGround Transportation
Sand & Gravel
Waste
Towing
Current Insurance Carrier
# of Vehicles in Fleet
Renewal Date
  

This form gives us the basic information we need, however we will need additional information to proccess a quote to your specific needs.
 
We will need the following information as we move forward.
  • Completed application signed & dated
  • Drivers List - MVR's if available
  • Vehicle List
  • Three to Fives years loss runs from prior insurance carriers

Martens-Johnson Insurance Agency - Ga  *  678.482.2254  *  678.377.1742 fax  *  tblanton@mjia.com