Tell us about your company?

What is your DOT #?(Required)

What is your EIN #?(Required)

Owners full name?(Required)

Best email address to send quotes to:(Required)

Phone?(Required)

Equipment Information:

Truck information:
Truck #1 Information:
Truck #1 is a:(Required)
Semi-truck
Box truck
Dump truck
Truck #1 VIN #?(Required)

Truck #1 year?(Required)

Truck #1 make?(Required)

Truck #1 stated value?(Required)

Is truck #1?(Required)
Company owned (not financed or leased).
Financed or leased.
Leased on by one of our drivers.
Truck #2 Information:
Truck #2 is a:(Required)
Semi-truck
Box truck
Dump truck
Truck #2 VIN #?(Required)

Truck #2 year?(Required)

Truck #2 make?(Required)

Truck #2 stated value?(Required)

Is truck #2?(Required)
Company owned (not financed or leased).
Financed or leased.
Leased on by one of our drivers.
Truck #3 Information:
Truck #3 is a:(Required)
Semi-truck
Box truck
Dump truck
Truck #3 VIN #?(Required)

Truck #3 year?(Required)

Truck #3 make?(Required)

Truck #3 state value?(Required)

Is truck #3?(Required)
Company owned (not financed or leased).
Financed or leased.
Leased on by one of our drivers.
Trailer Information:
What type of trailer coverage do you need?(Required)
We need to insure our trailers.
We need non-owned trailer coverage.
We need trailer interchange coverage.
We do not use trailers.
How much Non-Owned Trailer coverage do you need?(Required)
$25k
$30k
$40k
$50k
$60k
$65k
$70k
$75k
More - Will discuss with agent
How much Trailer Interchange coverage do you need?(Required)
$25k
$30k
$40k
$50k
$60k
$65k
$70k
$75k
More - Will discuss with agent
How many trailers do you need to insure?(Required)
You add up to 3 trailers here. We can add more later if you need to once the quoting process has started.
Insure 1 trailer
Insure 2 trailers
Insure 3 trailers
Trailer #1 Information:
Trailer #1 is a:(Required)
Trailer #1 VIN #?(Required)

Trailer #1 year?(Required)

Trailer #1 make?(Required)

Trailer #1 stated value?(Required)

Is trailer #1?(Required)
Company owned (not financed or leased).
Financed or leased.
Leased on by one of our drivers.
Tailer #2 Information:
Trailer #2 is a:(Required)
Trailer #2 VIN #?(Required)

Trailer #2 year?(Required)

Trailer #2 make?(Required)

Trailer #2 stated value?(Required)

Is trailer #2?(Required)
Company owned (not financed or leased).
Financed or leased.
Leased on by one of our drivers.
Trailer #3 Information:
Trailer #3 is a:(Required)
Trailer #3 VIN #?(Required)

Trailer #3 year?(Required)

Trailer #3 make?(Required)

Trailer #3 stated value?(Required)

Is trailer #3?(Required)
Company owned (not financed or leased).
Financed or leased.
Leased on by one of our drivers.

Owner and Drivers Information:
Owners Information:
This is information is required for underwriting if the owner drives or does not drive.
Owners date of birth?(Required)
Owners drivers license number?(Required)

Owner drivers license issued from?(Required)
Owner type of driver license?(Required)
Class A
Class B
Non-CDL
How many years has the owner had a Class A CDL?(Required)

How many years has the owner had a Class B CDL?(Required)

Do you need to add drivers?(Required)
Yes
No
How many drivers do you need to add?(Required)
You can add up to 3 drivers here. We can add more if needed as the quoting process moves forward.
Add 1 driver
Add 2 drivers
Add 3 drivers
Driver #1 Information:
Driver #1 full name?(Required)

Driver #1 drivers license number?(Required)

Driver #1 date of birth?(Required)
Driver #1 drivers license issued from?(Required)
Driver #1 type of driver license?(Required)
Class A
Class B
Driver #1 has had their Class A CDL how many years?(Required)

Driver #1 has had their Class B CDL how many years?(Required)

Driver #1 is a:(Required)
Company driver
Is leased on to our company
Driver #1 hire date?(Required)
Driver #2 Information:
Driver #2 full name?(Required)

Driver #2 drivers license number?(Required)

Driver # 2 date of birth?(Required)
Driver #2 drivers license insured from?(Required)
Driver #2 type of driver license?(Required)
Class A
Class B
Driver #2 has had their Class A CDL how many years?(Required)

Driver #2 has had their Class B CDL how many years?(Required)

Driver #2 is a(Required)
Company driver
Is leased on to our company
Driver #2 hire date?(Required)
Driver #3 Information:
Driver #3 full name?(Required)

Driver #3 drivers license number?(Required)

Driver #2 date of birth?(Required)
Driver #3 drivers license issued from?(Required)
Driver #3 type of driver license?(Required)
Class A
Class B
Driver #3 has had their Class A CDL how many years?(Required)

Driver #3 has had their Class B CDL how many years?(Required)

Driver #3 hire date?(Required)

Cargo Information:
Do you haul general freight (day van)?(Required)
Yes
No
What general freight cargo are you hauling?(Required)
Air Conditioning Equipment
Air Freight (Mail, UPS, & FedEx)
Amazon Goods
Appliances-- Major
Appliances-- Small
Audio, Video & Studio Equipment
Auto Parts & Accessories (not Tires)
Bakery Goods & Products
Beverage-- Beer
Beverage-- Liquor
Beverage-- Non-Alcoholic
Beverage-- Wine
Bottles-- Glass
Bottles-- Plastic
Candy & Confectionary (SL)
Cable & Wire (not Copper/Fiber Optics)
Camera Supplies & Accessories
Clothing-- Athletic (SL)
Clothing-- Blue Jeans (SL)
Clothing-- Designer, Clothing-- T Shirts (SL)
Computer-- Desktop (SL)
Computer-- Games & Software (SL)
Computer-- Gaming Systems (SL)
Electronic-- Accessories
Fashion Accessories (SL)
Furniture (new from factory)
Glass
Groceries (other than produce)
Handbags (SL
Hardware
Hazmat (two year hazmat endorsement required)
Lawn and Garden Equipment (SL)
Leather and Leather Goods
Machinery (Light & Non-precision)
Medical Diagnostic Equipment (SL)
Medical Supplies (not Medicine or Drugs) (SL)
Office Equipment
Office Supplies
Optical Goods (SL)
Oriental Rugs
Paper, Paper Products & Printed Matter
Pharmaceutical Products-- Over the Counter (SL)
Plants-- Trees & Shrubs (other than Temp Controlled)
Plastic Products
Plumbing Supplies (other than Copper)
Produce (other than refrigerated)
Purses, Handbags, Wallets & Belts (SL)
Rubber Products (other than Tires)
Signs (SL)
Shoes (other than Designer & Athletic (SL)
Sporting Goods/Equipment
Stereos & Radios
Televisions
Textiles (Cloth)
Tires (SL)
Tobacco (unrefined)
Toiletries
Tools
Toys (Hobbies & Crafts)
Wood Products (other than Furniture)
Do you haul flatbed cargo?(Required)
Yes
No
What flatbed cargo are you hauling?(Required)
Agricultural Equipment
Building Materials
Coiled Steel
Contractors Equipment
Copper and Copper Products (Flatbed)
Flatbed Cable & Wire (not Copper/Fiber Optics)
Flatbed Cable & Wire - Fiber Optics
Landscaping Product
Machinery-- Heavy > 10,000 lbs (flatbed)s
Lumber, Pallets & Wood (processed)
Machinery-- Light < 10,000 lbs (flatbed)
Metal (other than Copper)
Oversized/Overweight Loads
Pipe (other than Copper)
Printing Presses
Rigging (any property requiring)
Solar Panels (SL required)
Stone Slab/Products (Marble, etc.)
Swimming Pools, Spas & Hot Tubs
Trailers (New for delivery)
Transformers
Turbines
Do you haul Reefer cargo?(Required)
Yes
No
What reefer cargo are you hauling?(Required)
Butter
Dairy Products
Eggs
Frozen Food
Ice Cream
Juice
Meat-- Boxed
Milk
Plants-- Cut Flowers
Plants-- Trees & Shrubs
Poultry
Produce
Seafood-- Fresh (other than Canned Seafood)
Seafood-- Frozen (other than Canned Seafood)
Do you haul hazmat cargo?(Required)
Yes
No
The owner must be a driver and have had their hazmat endorsement for at least three years and have at least three years of work history hauling hazmat. Do you meet these requirement?(Required)
Yes
No
We cannot offer hazmat quotes if the owner doe not meet these requirements. Please continue if you would like us to help with other insurance options.
What hazmat cargo are you hauling?(Required)
Class 1
Class 2
Class 3
Class 4
Class 5
Class 6
Class 7
Class 8
Class 9
Do you haul UIIA Intermodal cargo?(Required)
Yes
No
What is your SCAC Code?(Required)

Do you haul dump truck cargo?(Required)
Yes
No
What are you hauling with your dump trucks?(Required)

What Cargo are you hauling?(Required)
You selected NO to all the cargo options above. Please tell what cargo you will be hauling.

Document Upload:
Not required at this time but will speed up the quoting process.
We need _
- Loss runs reports
- Last 4 quarters of your IFTA reports>br>

Drop files here or

Max. file size: 1 GB.

Comments / Questions / Requests
Any additional information will be helpful.
Agree(Required)
By sending us your information you agree to our terms and conditions. And agree sending us your information does not create binding contract for either party. This is quote request only.
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Indiana Truck Insurance

Company Information:

New Authority Questions

Underwriting questions.

Tell us about your company?

Equipment Information:

Truck information:

Truck #1 Information:

Truck #2 Information:

Truck #3 Information:

Trailer Information:

Trailer #1 Information:

Tailer #2 Information:

Trailer #3 Information:

Owner and Drivers Information:

Owners Information:

Driver #1 Information:

Driver #2 Information:

Driver #3 Information:

Cargo Information: