Non-Fleet Quote

FOR OVER 75 YEARS AS A TRUCKING INSURANCE SPECIALIST WE’VE SUCCEEDED IN PLACING OUR CLIENTS WITH FINANCIALLY SOUND INSURANCE COMPANIES REGARDLESS OF ECONOMIC CONDITIONS PROVIDING:

BROADEST COVERAGE AVAILABLE
BEST RATES IN THE MARKETPLACE

Name incl. DBA’s
Address
Garaging City
Fax #
Contact Name
Phone #
Email*
Nature of Business
FEIN #
Commodities Hauled (by %)
Radius of Haul (by % of miles, 0-50 / 50 – 200 / 200 – 500 / 500+)
# of Years In Biz
MC #
DOT #
Fleet History
Mileage

Current Year
Mileage

1st Previous Year
Mileage

2nd Previous Year
Gross Receipts

Current Year
Gross Receipts

1st Previous Year
Gross Receipts

2nd Previous Year
# of power units

Current Year
# of power units

1st Previous Year
# of power units

2nd Previous Year
Coverage Requested
Auto Liability

Limit/Deductible
Physical Damage

Limit/Deductible
Cargo

Limit/Deductible
General Liability

Limit/Deductible
Phone
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Fleet History

Coverage Requested

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