• Commercial Trucking Insurance Application

    Commercial Trucking Insurance Application

    Owner-Operators • New Ventures • Fleets up to 10 Power Units
  • Business Type

  • 1. General Applicant Information

  • Proposed Effective Date From:*
     / /
    2 digit month, 2 digit day, 4 digit year
  • Proposed Expiration Date To:*
     / /
    2 digit month, 2 digit day, 4 digit year

  • Mailing Address:

  • Garage Address: (If this different from the mailing address.)
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof
  • New Venture:*

  • Click here

  • 2. Principal/Contact Owner Information

  • Principal/Owner Name:

  • Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year

  • Home Address

  • Format: (000) 000-0000.
  • Driver*

  • 3. Operations Description

  • Rows
  • Hazardous Materials:
  • Oversized Loads:
  • Passenger Transport:

  • 4. Insurance History

  • Effective Date:
     / /
    2 digit month, 2 digit day, 4 digit year
  • Expiration Date:
     / /
    2 digit month, 2 digit day, 4 digit year
  • Effective Date
     / /
    2 digit month, 2 digit day, 4 digit year
  • Expiration Date:
     / /
    2 digit month, 2 digit day, 4 digit year
  • Effective Date:
     / /
    2 digit month, 2 digit day, 4 digit year
  • Expiration Date:
     / /
    2 digit month, 2 digit day, 4 digit year
  • Loss History
    Rows
  • Non-Renewals/cancellations:

  • 5. Requested Coverage

  • Auto Liability Limits:
  • Uninsured / Underinsured Motorist:
  • Motor Truck Cargo:
  • Physical Damage:
  • General Liability Coverage:
  • if "yes”, General Liability Coverage:
  • Workers Compensation:
  • If, "yes", Workers Compensation Coverage:

  • 6. Driver Information

  • New Venture? Click here

  • Driver 1 Name

  • Date of Birth:
     / /
    2 digit month, 2 digit day, 4 digit year
  • Date of Hire:
     / /
    2 digit month, 2 digit day, 4 digit year
  • Termination Date
     / /
    2 digit month, 2 digit day, 4 digit year
  • Owner Operators:

  • Driver 2 Name

  • Date of Birth:
     / /
    2 digit month, 2 digit day, 4 digit year
  • Date of Hire:
     / /
    2 digit month, 2 digit day, 4 digit year
  • Termination Date
     / /
    2 digit month, 2 digit day, 4 digit year
  • Owner Operators:

  • Driver 3 Name

  • Date of Birth:
     / /
    2 digit month, 2 digit day, 4 digit year
  • Date of Hire:
     / /
    2 digit month, 2 digit day, 4 digit year
  • Termination Date:
     / /
    2 digit month, 2 digit day, 4 digit year
  • Owner Operators:

  • Driver 4 Name

  • Date of Birth:
     / /
    2 digit month, 2 digit day, 4 digit year
  • Date of Hire:
     / /
    2 digit month, 2 digit day, 4 digit year
  • Termination Date:
     / /
    2 digit month, 2 digit day, 4 digit year
  • Owner Operators:

  • Driver 5 Name

  • Date of Birth:
     / /
    2 digit month, 2 digit day, 4 digit year
  • Date of Hire:
     / /
    2 digit month, 2 digit day, 4 digit year
  • Termination Date:
     / /
    2 digit month, 2 digit day, 4 digit year
  • Owner Operators:

  • Driver 6 Name

  • Date of Birth:
     / /
    2 digit month, 2 digit day, 4 digit year
  • Date of Hire:
     / /
    2 digit month, 2 digit day, 4 digit year
  • Termination Date:
     / /
    2 digit month, 2 digit day, 4 digit year
  • Owner Operators:

  • Driver 7 Name

  • Date of Birth:
     / /
    2 digit month, 2 digit day, 4 digit year
  • Date of Hire:
     / /
    2 digit month, 2 digit day, 4 digit year
  • Termination Date:
     / /
    2 digit month, 2 digit day, 4 digit year
  • Owner Operators:

  • Driver 8 Name

  • Date of Birth:
     / /
    2 digit month, 2 digit day, 4 digit year
  • Date of Hire:
     / /
    2 digit month, 2 digit day, 4 digit year
  • Termination Date:
     / /
    2 digit month, 2 digit day, 4 digit year
  • Owner Operators:

  • Driver 9 Name

  • Date of Birth:
     / /
    2 digit month, 2 digit day, 4 digit year
  • Date of Hire:
     / /
    2 digit month, 2 digit day, 4 digit year
  • Termination Date:
     / /
    2 digit month, 2 digit day, 4 digit year
  • Owner Operators:

  • Driver 10 Name

  • Date of Birth:
     / /
    2 digit month, 2 digit day, 4 digit year
  • Date of Hire:
     / /
    2 digit month, 2 digit day, 4 digit year
  • Termination Date:
     / /
    2 digit month, 2 digit day, 4 digit year
  • Owner Operators:
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof

  • 7. Safety and Maintenance

  • Written Safety Program:
  • Vehicle Maintenance Program:
  • Filings:

  • 8. Vehicle Information

  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof

  • 9. Declarations

  • The applicant acknowledges that this application is for quoting purposes only. Insurance Professionals LLC may act as an agent for certain insurers or as a broker to access multiple markets.

    The applicant affirms that all information provided is accurate and complete to the best of their knowledge. Misrepresentation or omission of material facts may impact the ability to secure quotes or result in denial of coverage.

    By submitting this application, the applicant authorizes Insurance Professionals LLC to obtain necessary reports or records, including but not limited to motor vehicle reports (MVRs), claims history, credit information, and other documents required for quoting and underwriting.

    This application does not guarantee coverage. Policy issuance is subject to the insurer's approval and terms.

  • Date:
     / /
    2 digit month, 2 digit day, 4 digit year
  • Should be Empty: