Motor Carrier Insurance Application
… Details(Required)Commodity DescriptionRevenue %Largest Customer(s) for this commodity Add RemoveDo you Store Cargo Overnight?(Required) Yes No Maximum Value of Stored Items(Required) Average Value of Stored Items(Required) Maximum Number of Days Items are Stored(Required) Is Refrigeration Required for Stored Items?(Required) Truck and Trailer Storage LocationsTruck and Trailer Storage Locations(Required)Street AddressCityStateZipFully Fenced?Gated?Security Camera?24/7 Surveillance? YesNoYesNoYesNoYesNo Add Remove EquipmentList of Equipment(Required)YearMakeTypeVIN / SNValueLicense StateGarage CityGarage Zip Tractor – SleeperTractor – Day CabTruck – BoxTruck – DumpTruck – ReeferTruck – PickUpPrivate PassengerCargo VanTrailer – Flat or LowbedTrailer – DumpTrailer – Dry VanTrailer – ReeferChassis Add Remove DriversDrivers Operating Insured …
https://www.epicbrokers.com/truckersapplication/