Commercial Auto & Trucking Application

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Applicant Information

Primary business & contact details

Named Insured (Legal Business Name) *

DBA (Doing Business As)

FEIN / Tax ID *

Mailing Address *

City *

State *

ZIP Code *

✓

Business address is same as mailing address

Business / Physical Address *

City

State

ZIP

✓

Principal garaging address is same as mailing address

Principal Garaging Address

City

State

ZIP

Phone *

Fax

Email Address *

Website

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Business Details

Entity type, years in business, and existing policy info

Business Entity Type *

Years in Business *

Requested Effective Date *

Policy Term

Current / Prior Insurance Carrier

Prior Policy Number

Prior Policy Expiration Date

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Vehicle Schedule

List all vehicles to be insured

Tip: Include all power units, trailers, and non-owned vehicles that require coverage. Use the + button to add additional vehicles.

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Driver Schedule

All drivers who operate insured vehicles

Note: Include all regular and occasional drivers. MVRs may be ordered for underwriting review.

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Coverage Requested

Select desired coverages and limits

Liability Coverage Limit *

Additional Coverages Requested

✓

Comprehensive (Physical Damage)

✓

Collision (Physical Damage)

✓

Motor Truck Cargo

✓

Trailer Interchange

✓

Non-Owned Trailer

✓

Bobtail / Non-Trucking

✓

Uninsured / Underinsured Motorist

✓

Medical Payments

✓

General Liability

Motor Truck Cargo Limit

Cargo Deductible

Physical Damage Deductible (Comp)

Physical Damage Deductible (Collision)

Additional Insured / Certificate Holder

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Loss History

Claims and losses for the past 5 years

Has the applicant had any losses, claims, or accidents in the past 5 years? *

Yes

No

Has any insurer cancelled or non-renewed your coverage in the past 3 years? *

Yes

No

If yes, explain

✍️

Certification & Signature

Review and authorize this application

Applicant Certification: The undersigned, on behalf of the applicant, hereby declares that the statements made herein are true and correct to the best of their knowledge and belief. The undersigned authorizes the insurer to obtain any information necessary to process this application. Misrepresentation or concealment of material facts may result in denial of coverage.

Printed Name *

Title / Position *

Date *

Phone

Signature * (draw in box)

Draw signature here

Producer / Agent Name

Agency Name

Agent License Number

Agent Phone

Agent Email

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Supporting Documents

Optional — upload any relevant documents (max 5MB each)

Driver's License(s)

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Click to upload

PDF, JPG, PNG

CDL / License Copy

🪪

Click to upload

PDF, JPG, PNG

Vehicle Registration(s)

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Click to upload

PDF, JPG, PNG

Current Insurance Dec Page

🛡️

Click to upload

PDF, JPG, PNG

DOT Authority Letter / MC Certificate

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Click to upload

PDF, JPG, PNG

Application Submitted

Thank you. Your Commercial Auto & Trucking application has been received. A representative will contact you within 1–2 business days.

Reference #:

Commercial Auto & TruckingApplication

Application Submitted

Commercial Auto & Trucking
Application