Trucking Insurance Quote "*" indicates required fields 1Basic Info2Contacts & Drivers3Trucks & Trailers4Commodities5Additional Insureds6Wrapping Up Basic InformationIs your business currently insured?* Yes No Insurance Carrier Name*Current policy expiration date* Month Day Year How many years of insurance under the same business name?*Is this a new venture or was there a lapse in coverage?* New Venture Lapse in Coverage When and why did the lapse in coverage occur?*Desired Coverages*(Select all that apply) Auto Liability Physical Damage Cargo General Liability Bobtail Non-trucking Liability Umbrella / Excess Commercial Property Occupational Accident Workers Comp Hired / Non-Owned Auto What Effective Date do you want for your policy?* Month Day Year Do you have a DOT#?* Yes No Pending DOT#*Do you have an MC#?* Yes No Pending MC#*Do you have a Tax ID#?* Yes No Pending EIN / TNN*How is the business structured?* Sole-Proprietor Partnership LLC Corporation Other What is the name of the business?*Has the business either currently or previously worked under a DBA? No Yes What is/was the DBA?Website: Business Mailing Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Business Garaging Address* Same as Mailing Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Are all vehicles garaged at the business address? Yes No Year Business Established* Primary ContactPrimary Contact Name* First Last Date of Birth* Month Day Year Primary Phone*Secondary PhoneSMS Follow-Up ConsentBy providing my phone number to Ameriguard Insurance Agency, I agree and acknowledge that Ameriguard Insurance Agency may send text messages to my wireless phone number for any purpose. Message and data rates may apply. Message frequency will vary, and you will be able to Opt-out by replying “STOP”. For more information on how your data will be handled please visit https://www.ameriguardinsurance.com/privacy/ By clicking on this box you are agreeing to receive a text message from Ameriguard Insurance AgencyEmail* Designated Financial Responsibility for Company?* Yes No What is your Role in the Company?* Owner / Operator Management Other Owner / Operator - Both a manager and included on the policy as a driver. Manager - Strictly management; is NOT a driver on the policy. Other - Any other party that has been authorized to contact us on behalf of the company, particularly to make modifications to their Policy / Coverages.Driver's License Number*Drivers License State* AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Year CDL Originally Issued*How many years of management experience?*How many years of trucking experience?*Is there a secondary business contact?* No Yes Secondary ContactSecondary Contact Name* First Last Date of Birth Month Day Year PhoneEmail Designated financial responsibility for company?* Yes No What is your Role in the Company?* Owner / Operator Management Other Owner / Operator - Both a manager and included on the policy as a driver. Manager - Strictly management; is NOT a driver on the policy. Other - Any other party that has been authorized to contact us on behalf of the company, particularly to make modifications to their Policy / Coverages.Driver's License NumberDrivers License State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Year CDL Originally IssuedHow many years of Management Experience?How many years of Trucking Experience?Do you have additional drivers? Yes Additional DriversAdditional Drivers*NameDate of BirthDriver's License NumberYear CDL IssuedYears of Trucking Experience Add RemoveClick plus symbol to add additional drivers Truck InformationCurrent Fleet Size123456+Vehicle 1: VIN*Vehicle Type*Radius of Travel*- Select -50 Miles100 Miles200 Miles300 Miles500+ MilesYear*Make*Model*Garaging ZipComprehensive or Collision Coverage? Yes No Vehicle Value Estimate*Permanent Attached Equipment? Yes No Equipment Value Estimate*Vehicle 2: VIN*Vehicle Type*Radius of Travel*- Select -50 Miles100 Miles200 Miles300 Miles500+ MilesYear*Make*Model*Garaging ZipComprehensive or Collision Coverage? Yes No Vehicle Value Estimate*Permanent Attached Equipment? Yes No Equipment Value Estimate*Vehicle 3: VIN*Vehicle Type*Radius of Travel*- Select -50 Miles100 Miles200 Miles300 Miles500+ MilesYear*Make*Model*Garaging ZipComprehensive or Collision Coverage? Yes No Vehicle Value Estimate*Permanent Attached Equipment? Yes No Equipment Value Estimate*Vehicle 4: VIN*Vehicle Type*Radius of Travel*- Select -50 Miles100 Miles200 Miles300 Miles500+ MilesYear*Make*Model*Garaging ZipComprehensive or Collision Coverage? Yes No Vehicle Value Estimate*Permanent Attached Equipment? Yes No Equipment Value Estimate*Vehicle 5: VIN*Vehicle Type*Radius of Travel*- Select -50 Miles100 Miles200 Miles300 Miles500+ MilesYear*Make*Model*Garaging ZipComprehensive or Collision Coverage? Yes No Vehicle Value Estimate*Permanent Attached Equipment? Yes No Equipment Value Estimate*Additional VehiclesDo you have any trailers you want to insure? Yes No Trailer InformationTrailer List*Serial NumberFull DescriptionRadius of Travel (Miles)Garaging Zip Add RemoveClick plus symbol to add additional trailersAdditional Trailer Notes CommoditiesWhat types of commodity do you haul?Primary Commodity*Percent of Business*Please enter a number from 0 to 100.Secondary Commodity (If Any)Percent of BusinessPlease enter a number from 0 to 100.Other Commodities (If Any) Additional InsuredsDoes anyone need to be listed as Additional Insured? Yes No Additional Insured(s) InformationAdditional Insured FilesIf your AIs have documents or requirements you may upload those here. Drop files here or Select files Accepted file types: pdf, Max. file size: 2 MB, Max. files: 10. How were you referred to us?Additional CommentsAttach File(s)If you have pictures or current coverage documents that you think would be helpful, please upload them here. Drop files here or Select files Accepted file types: pdf, png, jpg, Max. file size: 2 MB.
