Trucking Insurance Quote

Complete the details below to get your customized trucking insurance quote

Complete this form for fleets with less than 10 trucks.
For fleets with over 10 trucks, call us at 706-531-2510.

* Indicates required field

F.E.I.N.# *

Business Name *

DOT# *

How many Employee *

Effective Date *

Years in Business *

MC# *

Are you a Contract or Common Carrier? *

Contact Person Name *

Email *

Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

If you have more than 3 trucks, trailers and/or drivers please list on the equipment & driver page below.

History of Operations

Prior Year

Number of Trucks *

Total Miles *

Gross Receipts *

Current Year

Number of Trucks *

Total Miles *

Gross Receipts *

Cargo Transported

Type of Cargo *

Maximum Value *

% Transported *

Average Value *

Vehicle Schedule

Truck #1

Year *

Make *

Model *

VIN # *

Stated Value *

Lienholder (if none, leave blank) *

Truck #2 (if necessary)

Year (Truck 2) *

Make (Truck 2) *

Model (Truck 2) *

VIN # (Truck 2) *

Stated Value (Truck 2) *

Lienholder Truck 2 (if none, leave blank) *

Truck #3 (if necessary)

Year (Truck 3) *

Make (Truck 3) *

Model (Truck 3) *

VIN # (Truck 3) *

Stated Value (Truck 3) *

Lienholder Truck 3 (if none, leave blank) *

Trailer #1

Year *

Make *

Model *

VIN # *

Stated Value *

Lienholder (if none, leave blank) *

Trailer #2 (if necessary)

Year (Trailer 2) *

Make (Trailer 2) *

Model (Trailer 2) *

VIN # (Trailer 2) *

Stated Value (Trailer 2) *

Lienholder Trailer 2 (if none, leave blank) *

Trailer #3 (if necessary)

Year (Trailer 3) *

Make (Trailer 3) *

Model (Trailer 3) *

VIN # (Trailer 3) *

Stated Value (Trailer 3) *

Lienholder Trailer 3 (if none, leave blank) *

If more than 3 trucks or trailers, please attach a separate equipment schedule *

Max file size: 20MB

Driver's Employed, including Company Owner = E Independent Contractors = O

Primary Driver Name *

State *

Date of Birth *

Driver's License # *

Hire Date *

Years with Class A CDL *

Driver 2 Name (if necessary) *

State (D2) *

Date of Birth (D2) *

Driver's License # (D2) *

Hire Date (D2) *

Years with Class A CDL (D2) *

Driver 3 Name (if necessary) *

State (D3) *

Date of Birth (D3) *

Driver's License # (D3) *

Hire Date (D3) *

Years with Class A CDL (D3) *

Equipment Schedule & Driver Roster

Trucking Business Name *

Truck #1

Year *

Make *

Model *

VIN # *

Owned or Leased *

Stated Value *

Paid Off? *

Truck #2 (if necessary)

Year (Truck 2) *

Make (Truck 2) *

Model (Truck 2) *

VIN # (Truck 2) *

Owned or Leased (Truck 2) *

Stated Value (Truck 2) *

Paid Off? (Truck 2) *

Truck #3 (if necessary)

Year (Truck 3) *

Make (Truck 3) *

Model (Truck 3) *

VIN # (Truck 3) *

Owned or Leased (Truck 3) *

Stated Value (Truck 3) *

Paid Off? (Truck 3) *

Truck #4 (if necessary)

Year (Truck 4) *

Make (Truck 4) *

Model (Truck 4) *

VIN # (Truck 4) *

Owned or Leased (Truck 4) *

Stated Value (Truck 4) *

Paid Off? (Truck 4) *

Trailer Information

Trailer #1

Year *

Make *

Model *

Owned or Leased *

VIN # *

Stated Value *

Paid Off? *

Trailer #2 (if necessary)

Year (Trailer 2) *

Make (Trailer 2) *

Model (Trailer 2) *

VIN # (Trailer 2) *

Owned or Leased (Trailer 2) *

Stated Value (Trailer 2) *

Paid Off? (Trailer 2) *

Trailer #3 (if necessary)

Year (Trailer 3) *

Make (Trailer 3) *

Model (Trailer 3) *

VIN # (Trailer 3) *

Owned or Leased (Trailer 3) *

Stated Value (Trailer 3) *

Paid Off? (Trailer 3) *

Trailer #4 (if necessary)

Year (Trailer 4) *

Make (Trailer 4) *

Model (Trailer 4) *

VIN # (Trailer 4) *

Owned or Leased (Trailer 4) *

Stated Value (Trailer 4) *

Paid Off? (Trailer 4) *

Driver Information

Primary Driver Name *

Driver's License # *

Date of Birth *

State of Licensed *

Gender *

Date of Hire *

Driver 2 Name (if necessary) *

Driver's License # (D2) *

Date of Birth (D2) *

State of Licensed (D2) *

Gender (D2) *

Date of Hire (D2) *

Driver 3 Name (if necessary) *

Driver's License # (D3) *

Date of Birth (D3) *

State of Licensed (D3) *

Gender (D3) *

Date of Hire (D3) *

Driver 4 (if necessary) *

Driver's License # (D4) *

Date of Birth (D4) *

State of Licensed (D4) *

Gender (D4) *

Date of Hire (D4) *

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