As
of 10/16/06 we are temporarily not writing small fleets of less than
10 units and individual owner operators. Please check back as we
will be writing these again in the future.
Welcome to Transure Select's online quote
form; your gateway to receiving a truck insurance quote for any of the following coverages, Auto Liability, Physical Damage, Cargo, General
Liability, and Bobtail Liability (non-trucking) through your truck insurance
specialists at Transure.
Promotional Code (if available):
Your Name:
* (* = Required Info)
Business Name:
*
Address:
*
Garage City:
*
County:
*
State:
* (if you are in a state other than listed here,
we currently cannot offer a quote)
Zip:
*
Phone Number:
*
Fax Number:
Email Address:
*
Confirm Email Address:
Federal Employer Identification or Social Security number:
*
Number of years in business?
*
Effective date requested
for coverage to begin?
*
Are you permanently leased to a FHWA licensed carrier (bobtail
coverage)?
yes
no *
For Hire FHWA Licensed Motor Carrier?
(Do you haul under your own authority?)
yes
no
*
If yes - MC Number:
DOT Number:
*
Commodities hauled:
% (must total 100%)
1.
*
2.
3.
4.
Total Revenue:
*
Total Mileage:
*
Est. Mileage per State:
*
Additional States (list all on same
line):
Example: VA-25000, NC-35000, SC-22000
Tractors, Trailers, & Straight
Trucks *
We currently
cannot quote Pickup-Trucks.
(must enter info on at least one
unit)
Model
Year
Vehicle Type
Make or
Brand
Stated Value
Radius of Operation
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Greater than 10 Trucks, Tractors, or Straight Trucks? Check here
and we will contact you for additional information.
Drivers
(including owner operators): * (must
enter info on at least one driver) *
Name of
Driver
License
Number
Years of
Experience
Date of Birth
# of moving violations
# of accidents/ losses
Greater than 5 drivers? Check here and we will contact you for
additional information.
Please explain any moving violations
(date and type) and give dates/details
of any auto liability accidents in the box below:
Coverages Required
Auto Liability (AL)
Primary Liability Insurance:
(maximum 1,000,000)
yes
no * Filing needed?
yes
no *
Name of current primary liability
insurance company:
Current AL Premium:
AL Deductible:
Select Limit:
AL quote includes state minimum limits for uninsured motorists
coverage.
Higher limits available upon request.
Cargo (MTC)
Cargo insurance:
yes no
* Filing needed?
yes no
*
Name of current cargo
insurance company:
Current MTC Premium:
Cargo Limit:
Cargo Deductible:
Refrigeration breakdown coverage:
yes
no *
Any cargo losses in the last 3 years?
yes
no *
If yes, explain:
Physical Damage (P/D)
Physical Damage insurance:
yes no
*
Physical Damage Deductible:
Name of current physical damage
insurance company:
Current P/D Premium:
Do you need to insure a non-owned trailer?
yes
no *
Trailer Interchange
Limit:
Other:
Any physical damage losses in the
last 3 years?
yes
no *
If yes, explain:
General Liability (GL)
Do you want general liability insurance:
yes
no *
Name of current general liability insurance company:
If yes: Total payroll amount:
Total driver payroll amount:
Any GL losses in the last 3 years?
yes
no *
If yes, explain:
Other coverages
Bobtail (non trucking liability):
yes no
*
Occupational Accident Coverage:
yes
no *
Why are you shopping for
other coverage?
*
Where did you learn about Transure Select?
*
If other:
Other information you feel may
assist us in providing you a quote:
By submitting a quote request, you
acknowledge that credit reports and motor vehicle reports may
be reviewed as part of the quote process. To protect your privacy,
we will not share the information with anyone except the insurance
organizations we request to quote your coverage.
You also acknowledge that completion of
this form is not to be construed as a solicitation nor does it
obligate us to provide a quote. You acknowledge that the above
information is true and any quote received will be based on this
information. False reporting of information can jeopardize
your insurance coverage.
