Affordable Truck Insurance

Start - Step 1 of 8

How can we get a hold of you?

Contact name *

Best contact number *

Best Email to send quote *

Mailing address *

Address Line 1

Address Line 2

City

State

Zip Code

Do your equipment park at the mailing address? *

Garaging address

Address Line 1

Address Line 2

City

State

Zip Code

How is your business set up?

Individual / Sole Proprietor
Partnership
Corporation or LLC

Partner in Business

Owner of the business *

First

Middle

Last

full legal name

Date of birth *

Do you drive

Active Driver
Excluded as a Driver

Drivers license number *

License state

Do you have a commercial drivers license (CDL)? *

When did you get your CDL

Month / Year

Partner in Business

Co-Owner of business

First

Middle

Last

full legal name

Date of birth

Do you drive

Active Driver
Excluded as a Driver

Drivers license number *

License State *

Do you have a commercial drivers license (CDL)? *

When did you get your CDL

Month / Year

Do you need filings?

What is your US DOT Number? *

Do you don't have a DOT NUMBER enter 999999

Do you have a motor carrier (MC) Number?

Only needed if you cross state lines

MC Number

Do you need a state filing? *

Filing Number

Is your business For-Hire or Not For Hire

For Hire | Trucking For a Fee
Not For Hire | Haul Own Goods

How would you define your business type *

Ag Hauler
Auto Hauler
Building Materials
Container Hauler
Debris Removal
Dirt, Sand and Gravel
Fuel Hauler
General Freight Hauler
Hotshot Transport
Household Mover
Livestock Hauling
Logging
Heavy Equipment
Oilfield Materials
Refrigerated Goods
Scrap Metal / Autos
Steel Hauler
Towing
Other

How would you define your business type *

Bricklayer
Cement
Demolition
Drywall Installer
Electrician
Framing Contractor
Florist
Gardner
General Contractor
Glass Installation
Glass Repair
HVAC
Landscape Contractor
Oilfield Materials
Painter
Plumber
Roofer
Snowplowing
Taxi Service
Uber / Lift
Other

what do you haul?

Do you want to add additional drivers?

How many drivers do you employ? *

Please attach driver list

our system is limited to 6 drivers. please attach your drivers list or email us

File Upload

Click or drag a file to this area to upload.

Driver # 1

Driver Name *

First

Last

Name as it appears on their license

Date of Birth *

Drivers license number *

License state *

When did you hire them?

Date of hire

Do they have a commercial drivers license (CDL) *

When did they get their CDL

Month / Year

Do you want to add a second driver?

Driver # 2

Name *

First

Last

Date of birth *

Drivers license number *

License state *

When did you hire them?

Date of hire

Do they have a commercial drivers license (CDL) *

When did they get their CDL

Do you want to add a third driver?

Dri # 3

Name *

First

Last

Date of birth *

Drivers license number *

License state *

When did you hire them?

Date of hire

Do they have a commercial drivers license (CDL)? *

When did they get their CDL

Do you want to add a fourth driver?

Dri # 4

Name *

First

Last

Date of birth *

Drivers license number *

License state *

When did you hire them?

Date of hire

Do they have a commercial drivers license (CDL)? *

When did they get their CDL?

Do you want to add a fifth driver?

Driver # 5

Name *

First

Last

Date of birth *

Drivers license number *

License state *

When did you hire them?

Date of hire

Do they have a commercial drivers license (CDL)? *

When did they get their CDL?

Do you want to add a sixth driver?

Driver # 6

Name *

First

Last

Date of birth *

Drivers license number *

License state *

When did you hire them?

Date of hire

Do they have a commercial drivers license (CDL)? *

When did they get their CDL?

Equipment List

How many units do you own?

Counting both trucks and trailers

Please attach equipment list

our system is limited to 10 units. please attach your equipment list or email us

File Upload

Click or drag a file to this area to upload.

Unit # 1

Equipment Type *

Year *

Make

Body Type Truck *

Body Type Trailer *

Vin Number

Body type of vehicle *

Do you want add physical damage *

Stated amount *

Comprehensive deductible

Collision deductible

Please note, if requested deducible is not available, we will select the next available deductible.

Do you want to add a second unit?

Unit # 2

Equipment List *

Year *

Make

Body Type Truck *

Body Type Trailer *

Vin Number

Body type of vehicle *

Do you want to add physical damage *

Stated amount *

Comprehensive deductible

Collision deductible

Please note, if requested deducible is not available, we will select the next available deductible.

Do you want to add a third unit?

Unit # 3

Equipment Type *

Year *

Make

Body Type Truck *

Body Type Trailer *

Vin Number

Body type of vehicle *

Do you want to add physical damage *

Stated amount *

Comprehensive deductible

Collision deductible

Please note, if requested deducible is not available, we will select the next available deductible.

Do you wan to add a fourth unit?

Unit # 4

Equipment Type *

Year *

Make

Body Type Truck *

Body Type Trailer *

Vin Number

Body type of vehicle *

Do you want to add physical damage *

Stated amount

Comprehensive deductible

Collision deductible

Please note, if requested deducible is not available, we will select the next available deductible.

Do you wan to add a fifth unit?

Unit # 5

Equipment Type *

Year *

Make

Body Type Truck *

Body Type Trailer *

Vin Number

Body type of vehicle *

Do you want to add physical damage? *

Stated amount *

Comprehensive deductible

Collision deductible

Please note, if requested deducible is not available, we will select the next available deductible.

Do you want to add a sixth unit?

Unit # 6

Equipment Type *

Year *

Make

Body Type Truck *

Body Type Trailer *

Vin Number

Body type of vehicle *

Do you want to add physical damage *

Stated amount *

Comprehensive deductible

Collision deductible

Please note, if requested deducible is not available, we will select the next available deductible.

Do you want to add a seventh unit?

Unit # 7

Equipment Type *

Year *

Make

Body Type Truck *

Body Type Trailer *

Vin Number

Body type of vehicle *

Do you want to add physical damage *

Stated amount *

Comprehensive deductible

Collision deductible

Please note, if requested deducible is not available, we will select the next available deductible.

Do you want to add a eighth unit?

Unit # 8

Equipment List *

Year *

Make

Body Type Truck *

Body Type Trailer *

Vin Number

Body type of vehicle *

Do you want to add physical damage *

Stated amount

Comprehensive deductible

Collision deductible

Please note, if requested deducible is not available, we will select the next available deductible.

Do you want to add an ninth unit?

Unit # 9

Equipment Type *

Year 9 *

Make

Body Type Truck *

Body Type Trailer *

Vin Number

Body type of vehicle *

Do you want to add physical damage *

Stated amount *

Comprehensive deductible

Collision deductible

Please note, if requested deducible is not available, we will select the next available deductible.

Do you want to add a tenth driver?

Unit # 10

Equipment Type *

Year *

Make

Body Type Truck *

Body Type Trailer *

Vin Number

Body type of vehicle *

Do you want to add physical damage *

Stated amount *

Comprehensive deductible

Collision deductible

Please note, if requested deducible is not available, we will select the next available deductible.

Radius of Operation

What percent will you be traveling the following radius in miles

% 0 - 100

% 100 - 200

% 201 - 300

% 300 - Unlimited

Will the applicant be crossing state lines *

Which states do you operate in?

Description of commodities hauled

Provide the 4 most common commodities, value and % of each

1) Commodity

Value

% hauled

2) Commodity

Value

% hauled

3) Commodity

Value

% hauled

4) Commodity

Value

% hauled

Prior insurance carrier

Do you have a copy of your loss runs *

Loss runs for the past 3 years is ideal

File Upload

Click or drag a file to this area to upload.

Effective Date

Insurance company name

Effective date

Insurance company name

Effective date

Insurance company name

Coverages

Some coverages levels are state specific, if you select a limit that is not available in your state, we will select the next available limilt

Auto liability (AL) *

Auto Liability (AL) *

Auto liability limit needed

Uninsured motorist (UM)

Medial payment

Do you need motor truck cargo (Cargo)?

Cargo Limits *

Cargo limit *

Do you need reefer breakdown coverage?

Do you need truckers general liability (GL)?

Truckers general liability limits *

GL limit *

Are you a truck broker?

Select which type of broker coverage you need

Hired Auto
Non-Owned Auto
Hired Auto / Non-Owned Auto
Any Auto

Total number sub-haulers *

Total gross sub-haul receipts *

Number of employees *

Do you need trailer interchange

Number of trailer *

Value of trailer(s) *

deductible

Do you have a written contract?

Please attach a copy of the contract, if available

Click or drag a file to this area to upload.

How can we get a hold of you?

How is your business set up?

Partner in Business

Partner in Business

Company Information

Do you need filings?

Is your business For-Hire or Not For Hire

Do you want to add additional drivers?

Please attach driver list

Driver # 1

Driver # 2

Dri # 3

Dri # 4

Driver # 5

Driver # 6

Equipment List

Please attach equipment list

Unit # 1

Unit # 2

Unit # 3

Unit # 4

Unit # 5

Unit # 6

Unit # 7

Unit # 8

Unit # 9

Unit # 10

Radius of Operation

Description of commodities hauled

Prior insurance carrier

Coverages