Motor Carrier Application  Logo

  • Motor Carrier Application

    Welcome! Please enter your DOT number to begin your application.

  • Motor Carrier Information

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  • Add Terminal Addresses

  • Operation questions - Required for all applications

  • Percentage of hauls by distance

  • Driver Questions

  • Please give overall driver details as below

  • Add all driver and owner information. Please include owner/driver information in driver list. If they are a non-driver owner, a DL is not required.

  • Download the templates below or upload a completed file with the following information:

    1. Driver / Owner Template - Driver/Owner file must include:

    Driver Type (Driver, Driver & Owner, Non-Driving Owner), First Name, Last Name, Email, DL Number (unless Non-Driving Owner), DL State (unless Non-Driving Owner), DOB, Social Security Number, Gender

    2. Trucking Fleet/Trailer - Trucking Fleet/Trailer must include:

    Vehicle Rate (24 FT Box Truck, Tractor, Auto Hauler, Trailer, Trailer (Auto Hauler)
    Trailer (Non-Owned)

    Class, Year, Make, Model, VIN, Stated Value, Include Lease GAP coverage? (Vehicle only: yes/no), Trailer Interchange? (Trailer only: yes/no), Description (Trailer only).

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  • Commercial Auto Liability Options

  • Physical Damage Options

  • Please give details of your existing Auto Liability / Physical Damage Insurance

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  • Motor Truck Cargo Options

  • General Liability Options

  • Ancillary Coverages

  • Cargo Questions

    Are companies: (If you contract on a released liability basis, please attach a copy of a specimen waybill showing how much liability you accept. Also, please give details of your additional valuation rates and the approximate annual level of additional valuation charges you receive.
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  • Type of Cargo

    Coverage does not apply for any of the following interests unless it is specifically accepted by the Underwriters and endorsed on to the policy. Accounts, bills, debts, evidence of debt, letters of credit, passports, documents, railroad or other tickets, notes, money, securities, currency, coinage, bullion, precious stones, jewelry, tobacco, cigars, cigarettes, pharmaceuticals, perfume, eau de toilette, non-ferrous metal in scrap and/or ingot form, furs, all forms of alcohol intended for human consumption other than beer, seafood unless canned, Meat, Livestock, Live Animals, Household goods / Personal Effects. Some programs may have further exclusions with respect to Garments and Electronics. For Clarification: Heavy electrical items such as switchgear, turbines, and generators, or kitchen appliances such as washing machines, dishwashers, microwave ovens, toasters, and irons shall not be considered to be electronics. Battery-operated or electrically operated toys with a unit value greater than $75 shall be deemed to be electronics.
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  • Please give details of your existing cargo insurance

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  • Vehicle Questions

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  • Agency Information

  • Declaration

    Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance containing any materially false information or conceals, for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime. I/We hereby declare that the statements and particulars given on this form are true to the best of my/our knowledge and belief and that I/we have not suppressed, withheld, or modified any material fact(s). I/We agree that should a policy be issued, this form INCLUDING THE DRIVER EXCLUSIONS AS PER QUESTION 12 shall be the basis of the contract, and that any change in the pattern of my/our trade or trade practices shall be advised to the Underwriters as soon as possible, who may, at their discretion, vary the terms and conditions of the contract. Type Full Name to Acknowledge Fraud Declaration* (Please enter your full name to sign that you have read and agree to the above disclaimers)
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