Commercial Insurance Solutions is fully trained to specialize in Insurance for the Trucking Industry.
All Agents in our office are fully licensed truck insurance specialists and our service is second to none! Please request a FREE Trucking Insurance Quote today.
DRIVER INFORMATION
#1
(if more than two drivers, list in remarks)
Name:
Birthdate:
Sex:
# Year's CDL & License #:
Number & Type of Accidents within last 3 years:
Number & Type of MINOR violations within last 3 years:
Number & Type of MAJOR violations within last 3 years:
Comments or Remarks?
DRIVER INFORMATION
#2 (if none, leave blank)
Name:
Birthdate:
Sex:
# Year's CDL & License #:
Number & Type of Accidents within last 3 years:
Number & Type of MINOR violations within last 3 years:
Number & Type of MAJOR violations within last 3 years:
Comments or Remarks?
COMMERCIAL VEHICLE #1: If more than 2 vehicles, list in remarks or call us at: 866-864-1511
Year of vehicle:
Make & Model:
Type (truck, tow-truck, bobtail, etc.):
Length in Feet:
Gross Vehicle Weight:
Stated Value: $
Radius of operation:
List Special Equipment & Values
(i.e., rack, tool box, etc.)
VEHICLE ID# (VIN):
(highly suggested for accurate rating)
This Vehicle is Garaged at What Zip Code?
VEHICLE #1
COVERAGES:
Select Type of Coverage Desired:
Nontruck Commercial Auto Liability
Primary Commercial Auto Liability
Primary Commercial Auto Liability:
$350,000 CSL
$500,000 CSL
$750,000 CSL
$1 Million CSL
Comprehensive & Collision:
NO Coverage
$250 Deductible
$500 Deductible
$1000 Deductible
Do you want Medical Coverage?
Yes
No
Uninsured Motorists?
Yes
No
Do you want General Liability? (Protects your business for damage you
are legally liable for bodily injury/property damage caused by an accident
involving your truck business operations that aren't directly caused by your
vehicle, i.e., premises of your delivery, advertising, etc.)
Yes
No
Do you want Motortruck Cargo Coverage? (If YES, list amount of coverage in box)
Yes
No
$
COMMERCIAL VEHICLE #2:
Year of vehicle:
Make & Model:
Type (truck, tow-truck, bobtail, etc.):
Length in Feet:
Gross Vehicle Weight:
Stated Value: $
Radius of operation:
List Special Equipment & Values
(i.e., rack, tool box, etc.)
VEHICLE ID# (VIN):
(highly suggested for accurate rating)
This Vehicle is Garaged at What Zip Code?
VEHICLE #2
COVERAGES:
Select Type of Coverage Desired:
Nontruck Commercial Auto Liability
Primary Commercial Auto Liability
Primary Commercial Auto Liability:
$350,000 CSL
$500,000 CSL
$750,000 CSL
$1 Million CSL
Comprehensive & Collision:
NO Coverage
$250 Deductible
$500 Deductible
$1000 Deductible
Do you want Medical Coverage?
Yes
No
Uninsured Motorists?
Yes
No
Do you want General Liability? (Protects your business for damage you
are legally liable for bodily injury/property damage caused by an accident
involving your truck business operations that aren't directly caused by your
vehicle, i.e., premises of your delivery, advertising, etc.)
Yes
No
Do you want Motortruck Cargo Coverage? (If YES, list amount of coverage in box)
Yes
No
$
List any other Special Remarks or Comments Here That Will Help Us Better Understand Your Insuarance Needs:
Send my quotation via:
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Call Me by Phone
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