NTL - DOT Compliance

NTL - DOT Compliance

Use this form if you have a DOT number and you want to add it to your policy.
Your Name*
Your Business Name*
Your Phone Number*
Please enter a valid phone number.
Your Email Address*
example@example.com
New DOT#*
Additional Premium Disclaimer:

I understand the the DOT requires full Auto Liability and $100,000 of Cargo Coverage if I add the DOT# to my policy. This will generate additional premium to my monthly progressive statement.

- Full Auto Liability can add an additional $3,000-$15,000 premium per year.

- Cargo coverage can add an additional $1,500-$5,000 premium per year.
Additional Premium Acknowledgement*

I Have Read the above "Additional Premium Disclaimer" and Acknowledge that my premium will increase by adding a DOT number to my policy.
I would like to proceed forward as follows:*

Go ahead and issue my policy with any additional premium and email me a confirmation.Call me with the amount that my policy will increase before issuing the change to my policy.
Signature*

Clear
Should be Empty: