Please enable JavaScript in your browser to complete this form.Name *FirstLastDOT/MC #:ACCOUNT PROFILE (prior 3 years)(prior 3 years)RevenueProposed, Current, 1st , 2nd and 3rd priorProposedCurrent1st Prior2nd Prior3rd PriorMilesProposed, Current, 1st , 2nd and 3rd priorProposedCurrent1st Prior2nd Prior3rd PriorTransporter Plates TotalProposed, Current, 1st , 2nd and 3rd priorProposedCurrent1st Prior2nd Prior3rd PriorTransporter: Heavy SeasonProposed, Current, 1st , 2nd and 3rd priorProposedCurrent1st Prior2nd Prior3rd PriorTransporter: Light SeasonProposed, Current, 1st , 2nd and 3rd priorProposedCurrent1st Prior2nd Prior3rd PriorDeliveriesProposed, Current, 1st , 2nd and 3rd priorProposedCurrent1st Prior2nd Prior 3rd PriorDo you deliver vehicles both ways?YESNOHow are the plates returned to you after the delivery is completed?How is the return trip handled?Does insured permit and pay for driver(s) to rent vehicles for their return trips?YESNODo you ever move vehicles (drive-away or toter) using plates not owned by you?YESNODo you tow a second vehicle?YESNOIf yes, how often is this done?Does the insured own any equipment?YESNOIf yes, please provide vehicle description(s) and how these owned units are utilizedIs the 2nd vehicle ever owned?YESNOAre all plates owned to be insured under this policy?YESNODRIVERS/OPERATORSHow many drivers use their own vehicles when working for you?Do you permit your drivers to tow their own vehicles?YESNOIf yes, who installs the hitches to the vehicle being towed?Do you obtain and maintain certificates of insurance from these drivers?YESNODo you have written contracts with each driver or operator?YESNOIf so, please attach a copyWHAT DO YOU TRANSPORT (# of deliveries or % of total deliveries)Motor homes and RVs:Tractor/Trailers or Truck/Trailer combinations:Vans/Custom vans:Cars/Private Passenger:Luxury or Sports cars:Trucks:GVW of trucks10,00010,000-20,00020,001-45,000Over 45,000Trucks are stacked/piggybacked?YESNO1 up:2 up:3 up:>3 up:Tractor/Trailer or Truck/Trailer Combinations:Trailers are stacked/piggybacked?YESNO1 up:2 up:3 up:>3 up:Buses:Seating capacity of buses:Less than 2020 and overTOTERS (# of deliveries or % of total deliveries)Campers:Mobile homes:Cars/Private Passenger:Luxury or Sports cars:Vans/Custom vans:Motorcycles, ATVs:Boats:Other:Trucks:GVW of trucks<10,00010,000-20,00020,001-45,000Over 45,000Trucks are stacked/piggybacked?YESNO1 up:2 up:3 up:>3 up: Semitrailers: insurance deliveries) Trailers, other than semitrailers:Semitrailers:How often are trailers stacked/piggybacked?1 up:2 up:3 up:>3 up: How often are semi-trailers stacked/piggybacked?1 up:2 up:3 up:>3 up:MAJOR customers & percentage of revenue or deliveries:ManufacturersDealersAuctionsWholesalersRental agenciesEnd-userPHYSICAL DAMAGE (for drive away) OR CARGO (for toters) COVERAGEDrive AwayMaximum value of any single unit being driven/delivered:Average value of any single unit being delivered:Average values on the road at any given time:TotersMaximum value for any single conveyance:Average value for any single conveyance:Average values on the road at any given time:Submit13746
