MM Insurance - Non-Trucking Liability

MM Insurance - Non-Trucking Liability

We have processed over 400 applicants and provide expedited proposals within 24- 72 hours (Depending Upon State), accurate every time, guaranteed. This is a FAST LANE, expedited service and requires an application fee, but puts you in the position to be on the road driving for C5 as soon as tomorrow.
Policy
Sender Name
Reply Email
example@example.com
Agency
Monday.com Title
Customer
First Name*
Last Name*
Full Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Date of Birth*

MonthDayYear
Date
Mailing / Billing Address (This Is The Location Where You Garage The Vehicle)*

Street Address

Street Address Line 2

CityState

Zip Code
Driver's License #*
Driver's License State (Abbreviation)*
Your Company Name (If Applicable) - Please Include LLC or Inc. If Applicable
Target Start Date

MonthDayYear
Date
Has this driver had any accidents or violations in the past 5 years? *NOTE* THIS COULD AFFECT PREMIUM PRICING AT TIME OF POLICY ISSUANCE.*

NoYes
Approximate Date of Accident/Incident*

MonthDayYear
Date
Description of Incident/Accident*
Are you storing/parking the vehicle in a location different than the mailing address above?*

YesNo
Address of vehicle when storing/parking.*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
DOT # (If Applicable), Leave Blank If Driving Under Someone Else's DOT Number.
FEIN # (If you are waiting on one, please type "Waiting")*
Do you own or lease/rent the vehicle?*

OwnLease
I am leasing/renting from:*

EnterpriseKingbee (You are required to purchase physical damage insurance from MM Insurance)Other
Vehicle Year (Vehicle Must Be 12 Years Or Newer To Qualify)*
Vehicle Make & Model*
Ex: Ford Transit
Vehicle VIN # (YOUR QUOTE WILL BE DELAYED UNTIL THE VIN IS PROVIDED FOR THE VEHICLE YOU OWN OR ARE RENTING)*
As of today, do you currently have coverage in force for this vehicle? If you do, a discount is applied of 10%*

YesNo
Please provide a picture of your current insurance card. REQUIRED.*

Cancelof
What carrier is the current coverage with?*
Ex: Progressive
Company you will be driving for.
In addition to Non-Trucking Liability, please select one of the following.*

I need Physical Damage CoverageI am getting Physical Damage Coverage through the truck rental companyI do not require Physical Damage CovergeShow Me A Video Explaining This In More Detail **DO NOT LEAVE THIS OPTION SELECTED WHEN SUBMITTING YOUR APPLICATION - AFTER YOU WATCH THE VIDEO PLEASE SELECT YOUR CORRECT OPTION ABOVE**
What deductible would you like? (Note: The higher the deductible, the lower the premium).

$1,000$2,000
What Is Physical Damage Coverage?
I would like uninsured/underinsured motorist coverage. (Electing this coverage does yield additional premium. This coverage is important but not required by trucking companies).

YesNoShow Me A Video Explaining This In More Detail **DO NOT LEAVE THIS OPTION SELECTED WHEN SUBMITTING YOUR APPLICATION - AFTER YOU WATCH THE VIDEO PLEASE SELECT YOUR CORRECT OPTION ABOVE**
Uninsured/Underinsured Motorist
Longest Distance Traveled (Away From My Home Address)*
Do You Need State Or Federal Filings (Please answer "Neither" if you are driving under another trucking company's authority):*

Neither (I am driving under someone else's authority)BothState OnlyFederal Only
What is your MC(Motor Carrier) Number or the MCS90 and Federal Filing*
In order for your Federal Filing to be accepted by the FMCSA your address on the insurance policy must exactly match the address on file with FMCSA. (Ex. Suite Number/Unit, Spacing etc.). I confirm that the address listed above PRECISELY matches the FMCSA address. PLEASE DOUBLE CHECK.*

YesNo
Please include the telematics discount of 5-10% on my proposal. I AM interested in enrolling in the app that monitors my speed, safe driving habits. (ie - Progressive's Telematics program is called SmartHaul).

YesNo
Non Trucking Liability coverage is not the same as full auto liability coverage. I will be driving under the authority of another company as a subcontractor. While I am driving under their authority (under load), I understand that their liability insurance is primary and responsible. If I am driving under my own authority, I need full auto liability coverage. Non Trucking liability coverage protects me (my vehicle) while I am driving not under load ONLY. Because the trucking company I drive for carries full auto liability while I am driving under load, I only need NTL coverage to cover the gap.*

I Acknowledge
**Error - Please Fix**

One of the questions above has "Show Me A Video Explaining This In More Detail" selected. Please select an appropriate answer otherwise your form cannot be submitted
I Understand & Acknowledge That There Is A Non-Refundable $25 Application / Processing Fee*

I Acknowledge

** Quote Turnaround **

If your home address (included in the application above) is listed in the following states you are in our expedited program and can expect a quote within 24 hours: AL, AZ, CO, FL, GA, IL, KS, MN, TN, TX, WI. If your address is located in the following states please allow 48-72 hours for your quote: CT, DE, MA, MD, MI, NV, NJ, NC, OH, PA, SC. If your address is not in these lists, we recommend that you contact a local agent.
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Credit Card Details
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Credit Card Number	Security Code
Card Expiration

MM Insurance - Non-Trucking Liability

**Error - Please Fix**

** Quote Turnaround **

Error - Please Fix

Quote Turnaround