Trucking Insurance

We have special programs with low pricing and strong coverage along with first-rate service that is guaranteed.

Just fill out below and click submit and we will get to work.
If you prefer to call, reach us at 800-591-9692.

Date:
Time of Request:
Name
Email
Phone Number
Address



Company Name
USDOT Number
MC Number
What State are you based in
Liability Limit
Cargo Limit
Current Carrier
Policy Expiration Date
Insurance Losses in the last 3 years
Yes
No

If so please provide a brief detail of the number and the $ amount of claims with dates. We will work to get the best quotes and be in touch for more detail.

Are you satisfied with your old broker’s service?
Yes
No

No, then what is the problem with your old Broker?

Vehicle 1:
Year:
Make:
Value:
Vehicle 2:
Year:
Make:
Value:
Vehicle 3:
Year:
Make:
Value:
Vehicle 4:
Year:
Make:
Value:
Vehicle 5:
Year:
Make:
Value:

Contact us or send schedule if more than 5 vehicles

Driver 1:
Name on License:
License Number:
Date of Birth:
Years of Experience:
Driver 2:
Name on License:
License Number:
Date of Birth:
Years of Experience:
Driver 3:
Name on License:
License Number:
Date of Birth:
Years of Experience:
Driver 4:
Name on License:
License Number:
Date of Birth:
Years of Experience:
Driver 5:
Name on License:
License Number:
Date of Birth:
Years of Experience:
States where do you travel regularly:
Other information helpful to underwriting or coverage desired:

Please note that insurance transactions, – requests to incept, change or otherwise alter coverage, – are NOT effective without written acknowledgement from the carrier issuing coverage. First Service will notify you in writing when the carrier has confirmed your request.