Carr & Associates, LLC. - Trucking Quote

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Trucking Quote

Trucking Insurance Quote

Contact Information

Contact Name:		Day Telephone:
Business Name:		Eve Telephone:
Street Address:		Fax:
City, State Zip:		Best Time To Reach You:
E-Mail Address:

Company Information

Number of Years in Business
Effective Date Requested for Insurance
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

1.
2.
3.
4.
	Total	100%

Tractors, Trailers & Straight Trucks

Type	Year	Make or Brand	Physical damage coverage?	Radius of Operation
1
Enter Stated Value: $			VIN #
2
Enter Stated Value: $			VIN #
3
Enter Stated Value: $			VIN #
4
Enter Stated Value: $			VIN #
5
Enter Stated Value: $			VIN #
6
Enter Stated Value: $			VIN #
7
Enter Stated Value: $			VIN #
8
Enter Stated Value: $			VIN #
9
Enter Stated Value: $			VIN #
10
Enter Stated Value: $			VIN #
Check here if you have more than 10 Trucks, Tractors, or Straight Trucks; we will contact you for additional information.

Drivers(Including Owner-Operators)

Name of Driver #1	License Number	License State	Years Experience	Date of Birth
1
# of Moving Violations	# of Losses or Accidents	Who have you been driving for in the past 3 years?
1
Name of Driver #2	License Number	License State	Years Experience	Date of Birth
2
# of Moving Violations	# of Losses or Accidents	Who have you been driving for in the past 3 years?
2
Name of Driver #3	License Number	License State	Years Experience	Date of Birth
3
# of Moving Violations	# of Losses or Accidents	Who have you been driving for in the past 3 years?
3
Name of Driver #4	License Number	License State	Years Experience	Date of Birth
4
# of Moving Violations	# of Losses or Accidents	Who have you been driving for in the past 3 years?
4
Name of Driver #5	License Number	License State	Years Experience	Date of Birth
5
# of Moving Violations	# of Losses or Accidents	Who have you been driving for in the past 3 years?
5
Check here if you have more than 5 Drivers; we will contact you for additional information.
Please explain any moving violations (date and type) and give dates of any accidents in the box below.

Coverages Required

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No coverage of any kind is bound or implied by submitting information via this online form

Information from you and other sources, such as your driving, claims and insurance histories, may be used to calculate an accurate price for your insurance.
We will not distribute information to other parties other than for insurance underwriting purposes.
By submitting this form, you agree to release us from any liability should this information be accidentally viewed by others.

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Customer Service

Carr & Associates, LLC.
711 5th Ave S Suite #210
Naples, FL 34102

Telephone: 239-348-3555
Toll Free: 800-700-6659
Fax: 800-303-1156
Email Us!: info@fci360.com

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