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Trucking Insurance Quote
Trucking Insurance Quote Form
Trucking Insurance Quote
Rhett Jessop
2021-11-01T17:42:06-06:00
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If so, please enter it here.
This quote is for:
(Required)
New Venture
Policy Renewal
Reinstatement
Leased on Owner / Operator
Business Name
(Required)
DBA Name
DOT Number
MC Number (If Applicable)
EIN / Tax ID
Desired Effective Date
Date You Applied for Authority (If Applicable)
MM slash DD slash YYYY
Insurance Renewal Date
Month
Month
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12
Day
Day
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31
Year
Year
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
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2004
2003
2002
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1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Business Owner's Name
(Required)
First
Last
Business Owner's Date of Birth
(Required)
Month
Month
1
2
3
4
5
6
7
8
9
10
11
12
Day
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
Year
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Phone
(Required)
Email
(Required)
Business Owner's or Financial Responsible Party's Address
(Required)
This should match the address on the Owner's Driver's License address
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Business Address
(Required)
Same as Business Owner's Address above
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Mailing Address
(Required)
Same as Business Owner's Address above
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
What kind(s) of truck(s) will you be running?
(Required)
Mark all that apply!
Semi Truck
Box Truck
Hotshot
Dump Truck
Tow Truck
Cargo Van
Garaging Zip Code
(Required)
Enter the zip code where the truck will be parked whenever it is not being driven.
ZIP Code
Will you be renting any trucks?
(Required)
Yes
No
General Note:
Every time you get a new rental truck, you must send a written request to make the vehicle change to your policy along with the vehicle information. Coverage will only be afforded once a formal confirmation such as an endorsement is sent back from the insurance provider.
How many rental trucks do you need covered?
(Required)
Which Rental Company will you be using?
(Required)
Budget
Penske
Ryder
Enterprise
Other
Operation Radius
(Required)
- Select -
0-50 Miles
51-200 Miles
201-500 Miles
501+ Miles
Average Radius of Operation
(Required)
Estimated Annual Mileage
(Required)
Trucks / Tractors
Please upload or enter in truck information to be scheduled to the quote/policy below. Note: This section is not rental trucks.
Trucks / Tractors Details
Trucks / Tractors Schedule File Upload
Excel, JPG, PDF, or Word Doc
Drop files here or
Select files
Max. file size: 12 MB, Max. files: 1.
Trailers (If Applicable)
Please upload or enter in trailer information to be scheduled to the quote/policy below.
Trailers Details
Trailer Schedule File Upload
Excel, JPG, PDF, or Word Doc
Drop files here or
Select files
Max. file size: 12 MB, Max. files: 1.
Is the Business Owner a Driver?
(Required)
Yes
No
Business Owner is:
(Required)
Married
Single
Driver's License Number
(Required)
License State
(Required)
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Does the Business Owner have a CDL?
(Required)
Yes
No
What year was the CDL issued?
(Required)
Add additional drivers here:
Driver Schedule File Upload
Excel, JPG, PDF, or Word Doc
Drop files here or
Select files
Max. file size: 12 MB, Max. files: 1.
Possible Policy Discount
Do you currently have commercial or personal auto insurance?
(Required)
This discount includes personal auto and commercial auto policies. If you have either type of policy, DO NOT skip this part!!! It's a very important discount that may help!
Yes
No
Current Insurance ID card or Declarations Page or COI
If you don't have this right now it's okay but you have to submit this documentation to keep the discount if available.
Drop files here or
Select files
Max. file size: 12 MB, Max. files: 1.
Do you have any other insurance policies listed below for the business?
(Required)
General Liability
Business Owner's Policy
None
What year did you incorporate your business?
ELD Provider
(Required)
If you haven't chosen an ELD provider yet, we highly recommend KeepTruckin. This discount will not apply for some policies unless you already have a truck and the device is active in it. Some insurance providers do not provide a discount for ELD's yet but those that do typically credit the policy more than the ELD actually costs. You can still sometimes get an ELD discount after the policy is bound, we just need to wait until you get it activated and then submit the information on it to the insurance carrier. If you are not sure, you should DEFINITELY get an ELD, regardless if a discount is available or not because they have shown to help manage owner operators and fleets with compliance and safety with daily operations. Unless you select "N/A", you consent to providing your ELD data to the insurance company. Drive smart, save money.
Big Road
Blue Ink Tech (BIT)
Continental VDO Roadlog
E Z Logz
ELD Mandate
Garmin International
Geotab
J.J. Keller & Associates
KeepTruckin
Linxup
Omnitracs, LLC
People Net
Rand McNally
Samsara
Teletrac Navman
Transflo
Truck X
Trucker Path
Verizon Connect
Other
N/A
Coverages
Would you like a quote for the minimum required auto liability limit to get your authority activated?
(Required)
This will only get your authority activated and will not include any coverages that you will need to haul off the load boards, for brokers, Amazon Relay, or other freight providers or shippers.
Yes
No
Do you plan on keeping the minimum limit for:
(Required)
Less than 90 days
At least 90 days
Do you plan on getting your own Authority within the next 12 months?
(Required)
Yes
No
Auto Liability
(Required)
Other
$750,000
$1,000,000
Deductible
(Required)
$1,000
$2,000
$2,500
Bobtail / Non-Trucking Liability Limit
This coverage is only available if you do not have DOT# and are leased onto a Motor Carrier
$300,000
$500,000
$750,000
$1,000,000
Cargo Limit
(Required)
N/A
Other
$50,000
$100,000
$150,000
$200,000
$250,000
Cargo Deductible
(Required)
N/A
$1,000
$2,500
Refrigeration Breakdown
(Required)
N/A
Yes
Commodities Hauled
(Required)
Select all that apply
Automobiles
Beverages (Alcoholic)
Beverages (Non Alcoholic)
Chemicals (Hazardous)
Chemicals (Non Hazardous)
Construction Equipment
Construction Materials (Flatbed trailers)
Containers
Dirt, Sand, and Gravel
Equipment (Flatbed trailers)
Farming / Agriculture
Food (Non Refrigerated)
Frozen Food (Not Seafood)
General Freight
Hazardous Materials
Logs
Machinery
Minerals
Pharmaceutical
Plants
Seafood (Fresh)
Seafood (Frozen)
Other
Do you need the UIIA endorsement?
(Required)
Yes
No
Trailer Interchange Limit
(Required)
N/A
$20,000
$30,000
$40,000
$50,000
Trailer Interchange Deductible
(Required)
N/A
$1,000
$2,000
$2,500
General Liability Per Occurrence
(Required)
N/A
$1,000,000
$2,000,000
General Liability Aggregate Limit
(Required)
N/A
$2,000,000
$3,000,000
On-Hook Limit
N/A
$30,000
$50,000
$100,000
On-Hook Deductible
N/A
$1,000
$2,000
$2,500
What type of Towing will you do?
Reposessions
Drive-Away
County / Municipality Rotations
Roadside / Breakdown
IFTA Reports File Upload
Note: If you are an over the road motor carrier and are required to file International Fuel Tax Agreement reports, some insurers may require this for a formal quote.
Drop files here or
Select files
Max. file size: 12 MB, Max. files: 1.
Loss Runs
Drop files here or
Select files
Max. file size: 12 MB.
Additional Comments
Any additional information you can provide regarding experience, safety equipment, company safety plans, company growth expectations, driver requirements, claim descriptions, etc. can be entered here and will be useful during the quoting process
Disclosure
(Required)
Most insurance companies use information from you and other sources, such as your driving, claims and credit histories, to calculate an accurate price for your insurance. New or updated information may be used to calculate your renewal premium. Each company's Privacy Policy explains how they disclose and protect your personal information and how you may access and correct it. I can provide a copy at your request. If selected, we may share your contact info with our affiliate partners.
I agree
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