Trucking Classifications Fact Finder
Cypress Insurance
General Agency Information
This section to be completed by agency personnel
Cypress personnel, please update with the date we bound coverage after receiving a signed application and coverage has been bound..
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Month
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Day
Year
Date
Was this fact finder completed by the call center?
Yes
No
Salespype Text Inbox Lead?
Yes
No
Outcomes?
Won Business
Not a competitive quote
Missed opportunity
Not a cultural fit
Were we able to present a competitive quote?
Yes
No
Please do not complete this question. Agency will assign this quote to the following agent for presenting options.
Ben Mosley
Logan Mosley
Lance Mosley
Please do not complete this question. Agency will assign this quote to the following Account Manager for servicing this customer
Lance Mosley
Stephen Hauss
Cypress Agent completing this application?
Ben Mosley
Logan Mosley
Lance Mosley
Your Company Information
Which Cypress campaign generated this lead?
DI of TX
BT, LLC
CITS
CIPAR
CIPKY
CIPMemphis
How did you hear about us?
Salespype Inbox
Text campaign
Voicemail campaign
Customer Referral
Internet Search
Website
Social Media
Progressive referral
Other
TAFS Referral
Who referred you
We are taking over 100 calls per day. If necessary, do you mind if I call you with your quote after 5 pm and before 8 pm local your time?
Yes please call
No, do not call me after 5 pm my time.
What State is the business domiciled in?
Alabama
Arizona
Arkansas
Colorado
Florida
Georgia
Illinois
Indiana
Kansas
Kentucky
Louisiana
Michigan
Mississippi
Missouri
New Mexico
North Carolina
Ohio
Oklahoma
South Carolina
Tennessee
Texas
Virginia
Wisconsin
Are you currently insured with Progressive or any other Carrier?
Yes
No
If you are currently insured, who is the Insurance Carrier?
What is your companies Dot #?
How many days are you into your 21 day process?
Day 1 - 5
Day 6 -9
Day 10 - 13
Day 14 - 16
Day 17 - 20
21 days and beyond
Today's date
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Month
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Day
Year
Date
How is your business structured?
Sole Proprietor/Individual
Partnership
Corporation / LLC / Non-profit
Do you have a DBA name and if so what is that name?
What is your business type: Trucker?
Hotshot
Box Truck
Tractor
Cargo Vans
Business Owners name?
First Name
Last Name
If you own the company 100% skip this question. If not, please include all Owners full name and ownership percentage and date of birth, drivers license #, state license was issued and is the license a CDL and if yes please provide the original issue date for the CDL?
Your Company Name?
Year you launched your company?
Physical Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mailing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What county is the physical address located in?
Owners Date of birth?
Primary Phone Number
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Area Code
Phone Number
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Vehicle & Equipment
Do any listed vehicles or load require a hazardous material placard?
Yes
No
Vehicle Type
Cargo Van
Box Truck
Pickup
Car Passenger
Truck Tractor
Other?
If you answered other to the prior question please describe the vehicle and include the vin#
If in a tractor, are you going to be power only?
Yes
No
What is the vehicles year, make & Model?
What is the vehicles Vin#?
Farthest one-way distance this vehicle typically travels (90%) or more of the time)?
50 miles or less
100 miles or less
300 miles or less
500 miles or less
More than 500 miles (unlimited)
What type of trailer hitch does the vehicle have?
Ball on bumper
Ball in bed
Tow boom
5th Wheel
None
Is this vehicle used for business, personal or both?
Business only
Business & Personal
Personal only
Is there a loan or lease on this vehicle
Yes
No
If there is a loan or lease what is the name of the additional insured & include what their address is and email contact address if you have this information
Do you need comprehensive or collision coverage to protect this vehicle in an accident or loss?
Yes
No
What is the value of the permanently attached equipment?
If this vehicle was sold today, how much would it be worth (excluding any permanently attached equipment)?
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Add another vehicle or a trailer?
Yes
No
Trailer Type
Dry Van
Gooseneck
Utility Trailer
Flatbed
Low - Boy Trailer
Year
Make
Vin #?
ARE WE TO USE A DUMMY VIN # FOR QUOTING BECAUSE THE VEHICLE OR TRAILER HAS NOT BEEN PURCHASED OR LEASED YET?
YES
NO
Zip code where the vehicle is garaged
Additional Notes:
Farthest one-way distance this trailer travels for work?
50 miles or less
100 miles or less
300 miles or less
500 miles or less
More than 500 miles (unlimited)
Is there a loan or lease on this trailer?
Yes
No
If you have a loan or lease please provide the name of the company holding the loan or lease, include their address and an email address if you have one
What is the value of the permanently attached equipment?
If this trailer was sold today, how much would it be worth (excluding any permanently attached equipment)?
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Driver Information & Email Address For You
Is the owner a driver?
Yes
No
Owners Drivers License #?
Owners Drivers License Issuing State?
Owner, Is your license a CDL license?
Yes
No
Owner, what was the year your CDL license was issued?
Are you married or single
Married
Single
Are you the only driver?
Yes
No
If you answered the previous question with a NO, please provide all drivers date of birth, license number, state the license was issued and if the driver has a CDL, what year was it issued and is the drive married. If you prefer to email the list please send to heather@cypressins.net
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What is the best email address to use for you?
Are you currently insured, personal or commercial auto policy?
Yes
No
Has the customer had continuous coverage for at least a year?
Yes
No
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Down Payment Assistance & Quoting Strategy
We do offer down payment assistance, are you interested in knowing more about this program?
Quoting Strategy (focus on 2 events, 1 st event is achieving your authorization to operate from the FMCSA, 2nd event is the day you begin operations. Both events have far different insurance requirement so we will provide quotes that address each event. Our base quote addresses event 1. What this does for you is provide a much lower down payment option and prevents you from paying for coverages that you don't need until you actually become operational. The operational quote addresses the 2nd event and will include all the coverages you will need to operate. The operational quote will include your premium and payment details so you will know what your payment will be once we add back in the coverages you need to operate. What does this look like in real time? There are 24-48 hours after we bind coverage before the FMCSA's website will update and reflect your insurance is in place and meets the minimum level of BIPD required. Once this happens it is typically 24-48 hours before they will approve and authorize you assuming you have everything else completed and are at your 21 days or beyond. That is at least four days where you don't need general liability, motor truck cargo, etc. Most customers will call me back the day before they plan to operate and ask me to add back in the coverages. It takes 10 minutes and there is no additional down payment and you are ready to rock and roll immediately after we update the coverages.)
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Coverages & Options Requested
What is your current Bodily Injury Liability Limit?
Non Trucking Liability
Physical damage only
State minimum or less
25K a person / 50K an accident
50K a person / 100K an accident
100K a person / 300K an accident
300K combined single limit
350K combined single limit
250K a person / 500K single limit
500K combined single limit
Do you have other coverages for your business?
General Liability
Business Owners Policy
None
Number of named additional insureds?
Number of named waiver of subrogation holders?
Is a blanket additional insured endorsement needed by contract?
Yes
No
Are state or federal filings required?
Yes
No
Do you wish to be signed up with a carriers program for ELD which may provide a discount in the current policy and the second year policy?
Yes
No
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What Bodily Injury and Property Damage Liability (BIPD) limits do you need?
100 K/ 300K / 50K
250K / 500K / 100K
350K CSL
500K CSL
750K CSL
1 Million CSL
What limit for Uninsured Motorist, Bodily Injury and UM Property Damage limits do you prefer?
Matching limits with BIPD
500K CSL
750K CSL
1 Million CSL
What deductible do you prefer
$ 1,000
$ 2,500
$ 5,000
Do you want medical payments in the event you have a passenger and they are injured and what limits do you prefer?
$ 5,000
$ 10,000
$ 25,000
$ 50,000
Do you want Rental Reimbursement coverage?
$ 100 a day /. $ 3,000 max
$ 300 per day / $ 9,000 max
Do you want roadside assistance if it is offered by the carrier?
Yes
No
Do you require "On-Hook" coverage
Yes
No
If you answered the previous question with a yes, what limit do you prefer?
What limit do you prefer for Motor Truck Cargo coverage?
$ 25K
$ 50K
$ 100K
$ 150K
$ 200K
$ 250K
$ 500K
Other
If you answered other to the prior question what motor truck cargo limit do you want us to quote?
What deductible do you prefer for Motor Truck Cargo coverage?
$ 1,000
$ 2,500
$ 5,000
Do you require Trailer Interchange Coverage?
Yes
No
If you need trailer interchange, what limit do you want us to quote?
$ 10K
$ 20K
$ 30K
$ 40K
$50K
$ 60K
$ 80K
Other
If you answered other to the prior question please state the limit you want for trailer interchange coverage?
Do you want non-owned trailer physical damage coverage?
Yes
No
If you want non-owned trailer physical damage coverage how many trailers will you be pulling and what is the trailer type (i.e., dry van, reefer, flatbed, etc.)?
Do you want your quote to include General Liability coverage?
Yes
No
If you answered yes, do you earn 100% of your income from for hire trucking operations?
Yes
No
Do you operate a warehouse or other premises to which your customers have access?
Yes
No
Are you involved in any type of set up or installation?
Yes
No
Do you operate on, transport to and or from oil and gas fields or is in any other way involved in oil and gas production, including but not limited to the fracking process?
Yes
No
Do you operate businesses other than the for hire trucking operations?
Yes
No
What General Liability limit do you desire?
1 million each occurence and 1 million aggregate
1 million each occurence and 2 million aggregate
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What is your business tax id? EIN#
Do you want to add your spouse / domestic partner to the policy as the second named insured?
Yes
No
Add any additional Notes here:
Do you want us to run you the most accurate quote? If so, please enter your social security number here.
What date do you need your coverage to begin?
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Month
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Day
Year
Date
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Success Indicator Questions
Cypress Insurance - we have collected data for thousands of accounts and strive to identify characteristics that predict success. We take this data and base recommendations for all our insured's and prospects in the hopes that we can bring far more value to your business through the sharing of "what other businesses like yours is doing to be successful." The key success indicator score predicts your likelihood to operate successfully during the first full year of operation. We seek to create an environment where our knowledge and recommendations can help you be successful which is a win for Cypress Insurance and a win for your company.
What is your most important concern when deciding on which insurance agency you will go with?
A. Price
B. Knowledge of the trucking industry
C. An insurance agency that is more interested in helping you to succeed and is price competitive.
How many years of experience do you have operating this type of vehicle?
1 -2 years
3 -5 years
5 plus years
Do you have a written business plan or are you working with the small business administration or another entity that provides small business learning opportunities?
Yes
No
Do you have a partner?
Yes
No
How often do you conduct a truck and trailer walkaround to verify that your equipment is all in working order?
Everyday
Once a week
Periodically
Would you describe your knowledge for the industry compliance standards, safety & the DOT inspection process as:
Below Average
Average
Above Average
How would you rate the importance for safety & compliance standards in operating your company?
A. No importance
B. Important
C. Moderately important
D. Most important element of your operations
Would you welcome educational opportunities that would improve your knowledge for Safety and the DOT inspection process?
Yes
No
How much revenue are you wanting to generate on a monthly basis?
0 - 5,000
5,001-10,000
10,001 - 15,000
15,001 - 20,000 or more
How will you obtain loads?
Dispatcher
Broker Relationship
Load Boards
Dedicated Contract
Dispatcher, Brokers & Loadboards
Amazon Contract
Do you have a factoring relationship?
Yes
No
If you do not have a factoring relationship would you mind if I have my partner company contact you?
Yes
No
Are you leasing your vehicles?
Yes
No
Do you have a loan on your vehicle?
Yes
No
Have you taken out a business loan through the SBA or local bank to fund your business venture or do you have another financial backer?
Yes
No
If we are able to provide you with a competitive insurance quote would you be willing to enter our Trucking Trailblazer program which is designed to improve your chances of having a successful year one of operation and beyond?
Yes
No
Maybe
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Operational Questions
Please describe your experience for each of your drivers who will be operating the truck we will be insuring? Years, companies worked, etc. This information is critical to placing coverage through Cover Whale.
Expected sales /revenue over the next 12 months
Do you want to know more about our partnership with TAFS for factoring, tire and fuel discount programs, truck financing or leasing options and much more?
Commodities Hauled - We ask for specifics in this section because pricing is very much impacted by the load characteristics you will typically haul. Thank you for the detail:
Public livery
Chemicals
Explosives
Flammable Materials
Fuel, Oil or LPG Exposures
Toxic Hazardous or Medical Waste Exposures
Loads that need oversize or overwide permits
House moving
Machinery
Lumber or building supplies
Poultry
Frozen perishables
Tobacco
Metal, sheets, coils, roll
Wood Chips
Paper products
Household goods
Miscellaneous general freight
Furniture pre assembled
Bulk Furniture direct to retail
Intermodal
Passengers
Garbage/Refuse
Grain, Feed & Hay
Beverages
Commodities Dry Bulk
Construction
Fresh Produce
US Mail
Motor Vehicles
Mobil Homes
Amazon Goods
General Freight
Other, specify in next question
If you selected other in the prior question please specify commodities hauled so we can provide you with the most accurate quote?
Any plans to haul hazardous cargo?
Yes
No
If you do plan on hauling hazardous cargo please describe specific type?
Can you provide a trailer interchange agreement? Power only operations will need to agree for providing a trailer interchange agreement.
Expected annual & mileage - estimate is fine.
Who do you typically haul for (I.e., Amazon, Fedex, anybody you can get a dispatched load with, etc.?
If this is a renewal is your current carrier offering renewal?
Yes
No
N/A
If your current carrier is not offering a renewal please provide details for their choice to decline offering renewal (I.e., claims, change in operations, etc.)
What is your renewal price?
Do you plan to operate under anyone else's authority?
Yes
No
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Additional Coverage Options
Do you require Intermodal coverage?
Yes
No
Do you require UIIA coverage
Yes
No
Do you want the quote to include bobtail coverage? NOTE: only select this coverage if you are running under another companies authority.
Yes
No
Do you want a quote for excess / umbrella coverage?
Yes
No
What excess / umbrella limit are you requesting?
Do you want the quote to include workers compensation coverage with employer liability limits of 100/500/100 or higher?
Yes
No
Other
If you want a quote for work comp, what is your expected payroll for your employees in total for the next 12 months?
Any questions or specific information you wish to provide?
Please sign this application and select the date in the next box.
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Today's Date
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Month
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Year
Date
This completes the questionnaire. Thank you for taking the time to provide us with the information that will allow our team to find you the best product with the best coverage and price. Please click submit at the bottom of this form.
May we represent the Lord our God with honor and integrity and receive His favor in our business relationship - Tim Carpenter, Cypress Insurance CEO, President and Chairman.
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Customer Information
To be completed by agency staff.
Do you have any questions we can answer for you?
If you have any files to upload as part of this submission please do so here:
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Customer Signature: This information has been reviewed by me and all information is accurate and correct.
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How would you rate your experience with our staff during the completion of this fact finder?
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5
5 being the best!
How likely are you to refer Cypress Insurance Trucking Solutions?
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Best
1 is Worst, 5 is Best
We enjoy encouraging our staff when they do an outstanding job! Please add any comments about your rating and interaction you had with our team during this call so we can have the opportunity to support our staffs growth with meaningful feedback.
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Agency Personnel Section
To be completed by agent completing this fact finder
Success Indicator Rating: 1-2 stars is likely to fail / 3 -4 stars moderate chance to succeed and 5 stars is likely to succeed
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2
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Worst
Best
1 is Worst, 5 is Best
Is this customer a good candidate for the Trailblazer Trucking Program?
Yes
No
Should this customer be required to participate in the Trailblazer Trucking Program based on their success indicator score?
Yes
No
Recommendations for this insured which would increase their ability to be one of the 60% of all new authorities to make it through the first year of operation?
Agent completing this fact finder form, please upload the success indicator rating scoresheet here.
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