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Truckers Quick Quote
2021-04-26T12:33:42-07:00
Truckers Quick Quote
1
Company
2
Contact
3
Operations
4
Underwriting
Company Name
*
Name
DOT Number
*
FEIN Number
*
Years Under Current Ownership
*
Number of Power Units
*
Policy Effective Date?
*
MM slash DD slash YYYY
Primary Contact Name
*
First
Last
Phone
*
Email
*
Company Owner(s) Name(s)
*
Number of Owner Operated Trucks
*
Number of Company Owned Trucks
*
Choose Applicable Types
*
Dry Van
Refridgerated
Flatbed
Tanker
Dry Bulk
Auto Hauler
Container
Dump
Other Types of Cargo (Not Listed Above)
What Are You Hauling? (Please be specific)
*
Which States Do You Haul To?
*
Cargo Limit Requested
*
Trailer Interchange Required
*
Yes
No
Truckers GL Required?
*
Yes
No
Current Year's Projected Total Revenue?
*
One Year Prior Total Revenue?
Two Years Prior Total Revenue?
Dedicated Routes?
*
Yes
No
Drivers Teams?
*
Yes
No
Drivers With < 2 Years Experience?
*
Yes
No
Passengers Allowed?
*
Yes
No
Please Share Any Driver Safety and Fleet Safety Program Details You Have Implemented.
Please Attach Current Policy, Drivers List, Equipment List, Loss History, and Last 4 Quarter's IFTA's
Drop files here or
Select files
Accepted file types: pdf, jpg, docx, Max. file size: 12 MB, Max. files: 10.
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