Texas trucker insurance


 

 

Submission Guidelines

  • Complete Application Below
  • 5 yr. loss runs
  • Historical Unit Count
  • Current Carrier info
  • Required Filings
  • New Authority / New Ventures  -  Download Form   (Still need the information below with New Ventures)

Please fax the above information to 936-309-0050 or email the information to TPIG@sbcglobal.net

 

 

Texas Truck Insurance Quote Request

 

Please provide the following information:

Insured Information:

Name

Business Name

Type Of Business (Sole Prop/Inc/LLC/Other)

Street Address

City

State/Province

Zip/Postal Code

County

Garaging Address

Garaging - City

Garaging - State/Province

Garaging - Zip/Postal Code

Garaging - County

Work Phone

Home Phone

Tax ID # or Social

FAX

E-mail

Years in Business:
Effective Date:
Business Description:

Schedule of Vehicles/Trailers

YearMakeVINGVWACV-Actual CashValue

Largest Cities Entered:

AtlantaBostonBuffaloCharlotte Chicago
Cincinnati ClevelandDallas/Fort WorthDenver Detroit
HartfordHoustonIndianapolisJacksonvilleKansas City
Little RockLos AngelesLouisvilleMemphisMiami
MilwaukeeMinneapolis/St. PaulNashvilleNew Orleans New York City
New Orleans Oklahoma CityOmahaPhiladelphiaPhoenix
PittsburghPortlandRichmondSt. LouisSalt Lake City
San DiegoSan Francisco SeattleTulsa  
Other Cities:123  
Radius TraveledAverage Trip Distance
(Rating Question)
 

Commodities Hauled - Percentages Of Each

1234  
56    

Leasing Info

Number of owned units:  
Number of leased units:  
Is insured hauling for hire?YesNo   

Driver Information

Name
DOB
CDL Number & State
Experience
Date of Hire/Lease
MVR Info

 

Coverages

Liab CSL: Excess Liab:U/M:
PIP:Comp. DED:SCOL DED:
Coll. DED:Med Pay: Cargo Limit:
Cargo DED: Reefer Breakdown: Excess Cargo:
GL CSL:Payroll: Non-trucking:
Other:MC#:TxDOT:
USDOT:Leased to:  
  Address:  

 

3-Year Prior Carrier and Loss History

Carrier
No. of Losses
Total $ Amount
Current Year
1st Prior Year
2nd Prior Year

 

Has previous coverage been cancelled or denied?YesNo If yes, please explain why:

Comments:

 
 

 

NEW!!! Roadside Assistance Program.
  Click Below for More Information.



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