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Inland Cargo Truck Quote Form
This is an indication quote only. A completed app must be received before a firm quote will be issued. This quote is not binding. Please fill in quote with as much information as possible; missing information will result in a delay in receiving your quote. We cannot assign this request to an underwriter unless all information is provided.
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Personal Information
First Name
Required
Last Name
Required
Physical Address
Required
Postal Code
Required
Mailing Address
Optional
Mailing Address Zip Code
Optional
Phone
Required
E-Mail
Required
New Venture
Optional
Yes
No
Years In Business/Experience
Optional
Type of Operation
Required
Prior Carrier
Optional
Canc/Non-Renewed
Optional
Losses (Required 3 yrs)
Optional
Losses (Required 3 yrs)
Number of Power Units
Optional
Radius of Operations
Optional
List Description of All Power Units
Required
List Description of All Power Units
Commodities Hauled
Optional
Limit Per Unit
Optional
List Name and Age of All Drivers
Optional
List Name and Age of All Drivers
Theft Protection - Please Describe
Optional
Theft Protection - Please Describe
Agent Name & Phone/Fax
Optional
Agent Name & Phone/Fax
Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to
contact us
.
Per the terms of our
online privacy policy
we will not resell your information to any third-party.