Commercial Trucking Insurance | Dave The Insurance Guy

Policy Information

When are you looking to Bind Coverage or when would you like policy to start? *

Insurance Down Payments are usually between $1000-$4000. Do you have that available? *

Have you received any insurance quotes yet? If so, with whom?

Business Information

1. Business Name (as it should appear on the policy) *

2. Tax Identification Number (TIN/EIN) *

DBA (Doing Business As) Name

Business Structure *

3. Primary Contact Number *

4. Mailing Address (for policy documents) *

5. Garaging Address (where vehicles are primarily parked) *

6. Nature of Business / Commodities Hauled *

7. MC Number

DOT Number

8. Radius of Operation (miles from terminal to furthest point) *

Date Business Started *

Gross Receipts Expected for This Coming Year *

9. Is this a new venture? *

Yes No

If no, please attach a Loss Run Report for the past 3 years.

Have you ever had insurance under this business before? *

Yes No

If so, which company?

Have you ever filed bankruptcy? *

Yes No

If yes, explain:

Commodity Transported Information

List Commodities *

% of loads for each Commodity

Average Value per Load *

Maximum Value per Load *

Do you haul Hazardous substances or materials? *

Yes No

Vehicle Information

13. Vehicle Details: (Attach for each vehicle)

Year *

Make *

Model *

VIN # *

Gross Vehicle Weight (GVW) lbs *

Ownership Status *

Owned Leased

14. Additional Vehicles to Be Added This Year? *

Yes No

If yes, how many?

Attachments Required

Copy of Driver's License (Owner & All Drivers) Motor Vehicle Record (MVR) for Each Driver Loss Run Report (if applicable) Vehicle Registration/Proof of Ownership

Upload Documents (Optional)

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Commercial Trucking Insurance Application

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