TRUCK INSURANCE QUOTE

*Contact Name:
 
*MC or US DOT#
*Contact Phone #:
Fax #:
E-Mail Address
*Garaging Zip Code:
*How many years have you been in business?
*Do you have 3 years of continuous insurance?
 Yes  No
*What is your average Radius, in miles one way?
 50 100 200 300 Unlimited
*Please List the most common types of
cargo you carry
Please check off the coverage for which you are requesting

Primary Liability
Trailer Interchange
Reefer Breakdown
Physical Damage
Motor Truck Cargo
Bobtail Liability
General Liability
Umbrella

 
Year
Make
Model
Current Value
G.V.W.
Type
Unit #1
Unit #2
Unit #3
Unit #4
Unit #5
Please provide any addtional information that you wish regarding the vehicles.

We will quote the following limits of coverage: $1,000,000 combined single limit of liability, $100,000 cargo, with $1,000 deductible, $1,000 comprehensive & collision deductibles.

Our proposal will be an estimate only and will assume that your drivers all have 5 years of similar driving experience and 2 or less minor incidents on their driving record. Final premiums will be based upon acceptable driver criteria and favorable loss experience.