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We are happy to know you are interested in becoming the newest member of the LAP family.

Please complete the following application so we can assign your account to one of our highly qualified agencies who will contact you within 24 hours to provide a free, no-obligation quote.

Business Mailing Address:

Owner/Principal Name:

Address where vehicles are principally garaged:

What are your age criteria for drivers?
Insert three years prior carrier information.

Drivers operating vehicles