Fleet owners please complete the form below and hit submit!

Company Name  

Phone

  

E-mail

MC Number                  
Contact Person Fax Website
City State Zip Code
Number of Trucks Types of Trailers Number of Trailers
Current Ex Date of Liability Ins. Current Ex Date of Cargo Ins Current Exdate of Phys Damage   Ins
Current Insurance Company for
Liability		 Current Insurance Company for Cargo Current Insurance Company for Physical Damage
Expiring Premium Expiring Premium Expiring Premium

Number of Years in Business
Please tell us any thing else about your company you think may be helpful before we contact you.

This form will provide Insurance Strategies, LTD with the basic information needed to review your account.  After receiving the above information, we will be better able to determine which programs you will qualify for and what additional information may be required.  We offer quick turnaround and you should be contacted within 48 hours of submitting your information. with the basic information needed to review your account.  

 

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Last modified: February 01, 2005