• Truck Insurance Application

    Full Coverage — Truck Insurance Broker | (317) 427-5599

  • Thank you for choosing Full Coverage LLC.


    Before you begin, please have ready:

    • Your DOT and MC numbers
    • Driver details (name, DOB, license number)
    • Vehicle details (year, make, model, VIN, value)
    • Any current insurance documents


    This takes about 5–10 minutes. Partial submissions are welcome — we'll follow up to help you finish.


    Questions? Call or text (317) 427-5599

  • GENERAL INFORMATION

    Provide your core business and contact information to begin the application.
  • What is your Business Structure?*
  • Format: (000) 000-0000.
  • Are all the vehicles kept at the primary Garaging Address?*

  • OWNER/PRINCIPAL

    Tell us who owns or leads the business.

  • DESCRIPTION OF OPERATIONS

    Describe how your trucking business operates and the type of freight you haul.
  • 1) Type of Operation*
  • Do you engage in operations other than trucking?*
  • 3) Has there been any change in the nature of operations, ownership, management or the name of the operation during the last five years?*
  • 5) Will you Travel Interstate or Intrastate?*
  • Metropolitan Areas Traveled Through or Into:*

  • Operation Details

    Answer the operation questions that help us understand your business risk and authority.
  • 1) Are filings required?*
  • 2) Do you arrange loads for others in your name or a different name, or act as a freight broker or freight-forwarder?*
  • 3) In circumstances where you are unable to accept a load (i.e. high capacity, unit down, etc.) do you handoff/refer loads to others?*
  • 4) Is all equipment operated under the applicant's authority scheduled on this application?*
  • 5) Is all owned equipment scheduled on this application?*
  • 6) Do the number of power units on this application match your MCS-150?*
  • 7) Do you lease your equipment to others?*
  • 7 a) If yes, who must provide primary liability coverage?
  • 8) Do you pull doubles or triples?*
  • 9) Do you engage in any residential deliveries?*
  • 10) Is any portion of your operation seasonal?*
  • 11) Do you use any team, hot seat, slip seating or relay driver operations?*
  • 12) Do you allow passengers other than company employees?*
  • 13) Do you operate mobile equipment subject to compulsory or financial responsibility law or other motor vehicle insurance law in the state where it is licensed or principally garaged?*
  • 14) Do you haul over size, over weight loads?*
  • 15) Do you hire escort vehicles?*
  • 15 a) If yes, do you require them to provide a certificate of insurance?
  • 16) Do you haul to/from well drilling sites or mines?*
  • 17) Are any of your vehicles powered by a source other than diesel or gasoline?*

  • DRIVER INFORMATION

    Share driver details and supporting documents.
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  • Upload a File
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  • IF YOU HAVE MORE THAN 2 DRIVERS PLEASE PROVIDE AN EXCEL SPREADSHEET WITH THE DRIVER CREDENTIAL. (FULL NAME, DOB, DOH, YOUR, LICENSE#, LICENSE STATE)

  • DRIVER HIRING, TRAINING AND SAFETY

    Tell us about your hiring, screening, and safety practices.
  • Indicate which of the following is part of your driver screening/hiring process:*
  • Indicate which of the following is part of your driver performance management process:*
  • Indicate which of the following is part of your written equipment management program:*

  • TRUCK TECHNOLOGY

    Provide details about the technology installed in your fleet.
  • Rows

  • 1. Indicate % of your power units have telematics installed? If none, leave blank and skip to next question:

  • 1) b. Do you use telematics data to manage driver?
  • 2) Are your trucks equipped with technology that enables platooning, semi-autonomous, autonomous operations, or other similar operations?
  • Does IFTA mileage include all Owner/Operator mileage?

  • INSURANCE HISTORY AND LOSS EXPERIENCE

    Share your insurance history and any prior loss experience.
  • 1) Has an insurance company cancelled or non renewed your policy in the last 3 years?

  • List the business names you’ve used in the past 3 years, along with their MC and DOT numbers. Also, write the names of your insurance companies during that time. (write NONE if NEW VENTURE)

  • SCHEDULE OF AUTOS

    List the vehicles that need coverage and upload a fleet file if helpful.
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  • Rows
  • Rows

  • COVERAGES

    Select the coverages you want quoted for your operation.
  • SELECT THE COVERAGE YOU NEED

  • CARGO INSURANCE

    Choose any cargo coverages that fit your hauling needs.
  • OPTIONAL CARGO COVERAGES: (Check all that apply)

  • TRAILER INTERCHANGE

    Complete trailer interchange details if you need that coverage.

  • ROADSIDE ASSISTANCE AND TOWING COVERAGE

    Choose roadside assistance and towing coverage options.
  • Do you want ROADSIDE ASSISTANCE AND TOWING COVERAGE?

  • UNINSURED / UNDERINSURED MOTORISTS AND NO-FAULT OPTIONS - Quoting Purposes Only

    Review optional uninsured and underinsured motorist choices.
  • UNINSURED / UNDERINSURED MOTORISTS AND NO-FAULT OPTIONS
  • Select the reporting basis you are using:

  • UNIVERSAL INSURANCE AUTHORIZATION, DISCLOSURE & BROKER AGREEMENT
    (For Use by Full Coverage LLC & Participating Insurance Carriers)

    IMPORTANT: This Authorization allows Full Coverage LLC to collect information, pre-populate carrier applications (including Northland Insurance Company), and submit insurance quote requests on your behalf.


    1. Purpose of This Authorization
    By signing below, the Applicant authorizes Full Coverage LLC, its licensed agents, and any appointed or non-appointed insurance carriers or underwriting partners (collectively, “Producers”), to:

    Collect information necessary to obtain insurance quotes.
    Pre-populate, complete, and submit any supplemental or carrier-specific applications—including but not limited to Northland Insurance Company—based on information provided by the Applicant.
    Communicate directly with the Applicant regarding rating, underwriting, documentation, and binding requirements.
    Verify all information necessary for underwriting, risk evaluation, and compliance with applicable law.
    This Authorization applies to new business, mid-term changes, and renewals.


    2. Consent to Obtain Motor Vehicle Reports, Background Checks & Investigative Consumer Reports
    The Applicant authorizes Full Coverage LLC and participating carriers to obtain:

    Motor Vehicle Records (MVRs)
    Commercial driving history & DOT records
    Criminal background screenings (where permitted by law)
    Loss runs & prior claims history
    Investigative consumer reports regarding character, general reputation, and mode of living (pursuant to the Fair Credit Reporting Act (FCRA))
    Upon written request, the Applicant may receive a description of the nature and scope of any investigative report obtained.


    3. Consent to Obtain Credit Reports & Credit-Based Insurance Scores
    In connection with this application for commercial automobile or any other insurance coverage, the Applicant authorizes:

    Full Coverage LLC
    Northland Insurance Companies
    Any other participating carriers
    to obtain credit reports and/or credit-based insurance scores, including through third-party vendors.
    Such information will be used solely for the purpose of underwriting or rating the insurance for which the Applicant applies.

    Authorization remains valid for renewals and future policy transactions unless revoked in writing.


    4. Consent to Communications (TCPA-Compliant)
    By signing, the Applicant authorizes Full Coverage LLC and its agents to contact them via:

    Phone calls (including prerecorded or automated calls)
    SMS/text messages
    Email
    Voicemail drops
    Electronic document delivery and e-signature requests
    These communications may include quote requests, underwriting questions, renewal reminders, or other insurance-related matters.
    Msg & data rates may apply. Consent is not a condition of obtaining insurance.

    The Applicant may opt out at any time by written request.


    5. Use of Application Information
    Information provided in this form may be used to:

    Pre-populate Northland applications
    Complete any required supplemental applications
    Submit quote requests to multiple carriers
    Determine eligibility, risk level, and rating
    Comply with state and federal underwriting requirements
    This Authorization does not bind coverage and does not amend any policy.


    6. Applicant Acknowledgements
    By signing, the Applicant agrees:

    All drivers and vehicles used for business or commercial purposes have been disclosed.
    The Applicant will immediately notify Full Coverage LLC of:

    New drivers
    New vehicles
    Garaging location changes
    Ownership changes
    Accidents, claims, or losses (regardless of fault)
    The Applicant acknowledges familiarity and compliance with current DOT Safety Regulations applicable to their operation.
    Completion of this document is for quoting purposes only. Binding coverage requires completion of carrier-specific, state-required, and Northland-required supplemental applications.
    Availability of coverage depends on underwriting qualifications and state law.

    7. Fraud Statements (Required by Law)
    ARKANSAS, MARYLAND, NEW MEXICO and OREGON: Any person who knowingly (or willfully in MD) presents a false or fraudulent claim for payment of a loss or benefit or knowingly (or willfully in MD) presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison.

    MAINE, TENNESSEE and WASHINGTON: It is a crime to knowingly provide false, incomplete, or misleading information to an insurance company for the purpose of defrauding the company. Penalties may include imprisonment, fines, and denial of insurance benefits.

    NEW JERSEY: Any person who includes false or misleading information on an application for an insurance policy is subject to criminal and civil penalties.

    OKLAHOMA: Any person who knowingly and with intent to injure, defraud or deceive any insurer makes any claim or submits information containing any false, incomplete, or misleading information is guilty of a felony.

    ALL OTHER STATES: Any person who knowingly, and with intent to defraud any insurance company or another person, files an application for insurance or statement of claim containing any materially false information, or conceals information for the purpose of misleading, commits a fraudulent insurance act, which is a crime.


    8. State-Specific Underwriting Notices
    Iowa, Illinois, New Mexico, Oregon, Washington, Wisconsin:
    Signing this application does not bind the company to offer insurance nor obligate the applicant to purchase it. The application and supporting documents form the basis of any policy issued.

    Montana: A single loss is among the insurance company’s criteria for nonrenewal.

    South Carolina: The insurer may cancel this policy without cause during the first 90 days; after that, cancellation is limited to reasons stated in the policy.


    9. Producer Compensation Disclosure (Northland Required)
    For information on how Northland compensates its agents, brokers, or program managers, please visit:
    https://www.travelers.com/w3c/legal/Producer_Compensation_Disclosure.html


    10. Certification & Signature
    By signing below, the Applicant:

    Confirms all information provided is true, accurate, and complete.
    Authorizes Full Coverage LLC to submit this information to multiple insurance carriers.
    Approves Full Coverage LLC to complete carrier applications on their behalf using information provided.
    Acknowledges all disclosures in this Authorization.
    Understands coverage is not bound until confirmed in writing by the carrier.

    11. Disclaimer
    This form is designed based on industry-standard insurance compliance practices. It is provided for general informational purposes only and is not legal advice. Consult a licensed attorney in your state for legal verification before relying on this document.

  • SIGNATURES

    Finish by signing and dating the application.
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