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TRUCK INSURANCE SPECIALISTS

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Commercial Carriers Insurance Agency
TRANSPORTATION
APPLICATION FOR QUOTE

 

 

DIRECTIONS: To receive a quote for your current truck insurance needs, simply complete the application and push "SUBMIT" - one of our account executives will contact you shortly. If for any reason you feel uncomfortable using our online application, contact us toll-free at (800) 229-8782 or use my direct line (562) 733-6526. Nathan Wallace, Marketing Supervisor.

We currently offer coverage in the following states:

General Information
 

  GENERAL INFORMATION

(Double check before submitting)

Please list any special notes you would like us to know about, such as issues with your current protection/service or special business operations.
How'd you hear about us?       
Other
Business information
 

  BUSINESS INFORMATION

Company Name      
Owner's Name
Your name
(if other than owner)
Phone Number
Garaging City
Radius of Operations     
Commodity
   If Other, list:  
Years In Business
Number of Drivers
   (if 1), Yrs Experience    
Equipment List
 

  EQUIPMENT LIST (Use 1 row for each vehicle type)

# of Vehicles  
   Vehicle Type    
   Value    
 
# of Vehicles  
   Vehicle Type    
   Value    
# of Vehicles  
   Vehicle Type    
   Value    
# of Vehicles  
   Vehicle Type    
   Value    
# of Vehicles  
   Vehicle Type    
   Value    
# of Vehicles  
   Vehicle Type    
   Value    
 
# of Vehicles  
   Vehicle Type    
   Value    
Insurance Information
 

  INSURANCE INFORMATION

Policy Expiration
Limit of Liability
Need ICC Filing?       
   
 
Need Cargo Coverage?       
   
      Limit Needed   
Losses (Last 3 years):
Tickets (Last 3 years):

Quote subject to change based upon verification of supplied information.

Affiliations

Meadowbrook Insurance Group | American Highway Carriers Association | California Trucking Association
Harbor Trucking Association | Progressive Independent Agent