Commercial Auto Application

1. Business Information

Legal Name

DBA Name

USDOT #

MC/MX #

Entity Type

Years in Business (Estimated)

FEIN / Tax ID

Operating Status

Safety Rating

Safety Rating Date

2. Contact Information

⚠ Please fill in all required fields before proceeding.

Physical Address

Street*

City*

State*

ZIP*

Mailing Address Same as physical

Street

City

State

ZIP

Garaging Address Same as physical

Street*

City*

State*

ZIP*

Phone & Email

Phone*

Fax

Email*

Website

Contact Name

Contact Title

3. Operations

Carrier Operation

Operation Classification Hold Ctrl to select multiple

Hazmat?

Passenger Carrier?

Cargo / Commodities Carried

Radius of Operations

States of Operation

4. Fleet Information

Power Units (Trucks)

Trailers

Drivers

Vehicle Schedule

Enter a VIN to auto-fill vehicle details from NHTSA, then verify and add to the schedule.

VIN #

or

📂 or drag & drop files here .xlsx .xls .csv .pdf .doc .docx .jpg .jpeg .png

#	VIN	Year	Make	Model	Type	GVWR	Value ($)

No vehicles added yet. Enter a VIN above to get started.

5. Driver Schedule

📂 or drag & drop files here .xlsx .xls .csv .pdf .doc .docx .jpg .jpeg .png

#	Name	Date of Birth	License #	State	CDL Class	Years Exp.	Hire Date
1

6. Prior Insurance & Loss History

Current/Prior Insurance Carrier

Policy Number

Expiration Date

Annual Premium ($)

BIPD Insurance on File (FMCSA)

Cargo Insurance on File (FMCSA)

Bond/Surety on File (FMCSA)

FMCSA Insurance History

Type	Insurance Carrier	Policy #	Coverage From	Coverage To	BI&PD Limit	Status

3-Year Loss History

Year	# of Claims	Total Incurred ($)	Description

7. Coverage Requested

When do you need this policy to start? *

Your policy will run for one year from this date.

Commercial Truck Insurance

Carrier Summary

1. Business Information

2. Contact Information

Physical Address

Mailing Address Same as physical

Garaging Address Same as physical

Phone & Email

3. Operations

4. Fleet Information

Vehicle Schedule

5. Driver Schedule

6. Prior Insurance & Loss History

FMCSA Insurance History

3-Year Loss History

7. Coverage Requested

8. Additional Notes / Remarks

Carrier Summary

1. Business Information

2. Contact Information

Physical Address

Mailing Address Same as physical

Garaging Address Same as physical

Phone & Email

3. Operations

4. Fleet Information

Vehicle Schedule

5. Driver Schedule

6. Prior Insurance & Loss History

FMCSA Insurance History View full history on FMCSA L&I View Active Insurance on FMCSA L&I ↗

3-Year Loss History

7. Coverage Requested

8. Additional Notes / Remarks

FMCSA Insurance History