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    • 7 Essential Tips to Secure the Best Insurance Rates for Your Trucking Business
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Trucking Insurance Application (Non Fleet) from Amber James

Get your commercial trucking insurance policy from Strong Insurance.

Trucking Insurance Application (Non Fleet) from Amber JamesGravity Certs2024-11-08T12:02:12-05:00

"*" indicates required fields

1Basic Info
2Coverages
3Contacts
4Trucks
5Trailers
6Drivers
7Commodities
8Wrapping Up
MM slash DD slash YYYY

Basic Information

Is your business currently insured?*
MM slash DD slash YYYY
Has the business either Currently or Previously operated under a DBA?
How is the business structured?*
Business Mailing Address*
Business Garaging Address
Are all vehicles garaged at the same location?*

Coverage Selection

Desired Coverages*
(Select all that apply)

Primary Contact

Primary Contact Name*
MM slash DD slash YYYY
Can we text you?
Primary Contact: What is your Role?*
  • Owner / Operator - Both a Manager and included on the policy as a Driver.
  • Manager - Strictly a manager, is NOT a Driver on the policy.
  • Other - Anyone besides the Owner / Management that has been authorized to contact us on their behalf, particularly to make modifications to their Policy / Coverages.
Is there a Secondary business contact?*

Secondary Contact

Secondary Contact: Name*
MM slash DD slash YYYY
Secondary Contact: What is your Role?*
  • Owner / Operator - Both a Manager and included on the policy as a Driver.
  • Manager - Strictly a manager, is NOT a Driver on the policy.
  • Other - Anyone besides the Owner / Management that has been authorized to contact us on their behalf, particularly to make modifications to their Policy / Coverages.

Truck(s)

VIN Year Make Model Actions
       
There are no Trucks.

Maximum number of trucks reached.

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Trailer(s)

VIN Year Make Model Actions
       
There are no Trailers.

Maximum number of trailers reached.

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Driver(s)

Do you have additional drivers?
Driver Name Drivers License # Drivers License State Actions
     
There are no Drivers.

Maximum number of drivers reached.

This field is hidden when viewing the form

Commodities

What type(s) of commodities do you haul? The grand total of all commodities should equal 100%.
 
Add Commodity 2
 
Add Commodity 3
 
Add Commodity 4
 
Add Commodity 5
 
Add Commodity 6
 
Add Commodity 7
 
Add Commodity 8
 
Add Commodity 9
 
Add Commodity 10
 
This should equal 100%
If you haul other commodities not listed above, please enter them here.
This field is hidden when viewing the form
Loss Runs, Last 4 Quarters of IFTA's, MVRs, Driver List, Vehicle List.
Drop files here or
Accepted file types: pdf, png, jpg, Max. file size: 2 MB.
    This field is hidden when viewing the form
    This field is for validation purposes and should be left unchanged.
    View Insurance Fraud Statement

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    118 W 3rd St
    Chadron, Nebraska 69337
    Phone: 308-430-1953

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    If your application contains purposefully misleading, absent, or inaccurate information, you could be charged with fraud. Your insurance carrier could potentially void your policy, or you could face civil or criminal charges or penalties.

    Any person who knowingly and with intent to defraud any insurance company or other person, files an application for insurance or statement of claim containing any materially false information or conceals, for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent act, which is a crime.

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