Shipman Insurance Agency

Get a Free Quote Now - Quote by Phone: 1-800-779-2964

Shipman Insurance Agency
301 Hwy 80 W
White Oak, TX 75693
United States
ph: 903-297-4456
fax: 903-297-5802
alt: 800-779-2964
tshipman@shipmaninsuranceagency.com

Truck Quote Form

Please complete the form below as fully as possible.

Company Name:

*First Name:

*Last Name:

*Email:

Please make sure it is an email you check regularly

Phone:

*Contact Preference:

Address Line 1:

Address Line 2:

City:

*State/Province:

ZIP/Postal Code:

Your Web Site:

How Long Have You Been In This Business?

Filings Needed:

US Dot # State Dot #

List Your Current DOT#s:

If you need filings we can help.

Current Insurer And Expiration Date:

List Drivers Names, Dates Of Birth, CDL#, Yrs. Experience And Any Tickets Or Accidents Within The Last 3 Yrs.:

If you have more drivers than will fit in this form please fax or email the list to us.

Please List Vehicles And Trailers: Year, Make, Vin#, Body, GVW, Value$.

If you have more vehicles than will fit in this form please fax or email the list to us.

*Please Click On The One That Applies:

I am emailing a list of additional drivers and vehicles to you? Send to: (tshipman@shipmaninsuranceagency.com) I am faxing a list of drivers and vehicles to you? Fax to: (903) 297-5802 There ar no more vehicles or drivers.

List The Major Cities Traveled:

Minimum Liability Limits Needed:

$500,000 $750,000 $1,000,000 Greater than $1,000,000

There are other limits available if needed.

Under insured/Uninsured Motorist Coverage limits:

There may be other limits available. Please indicate what limit you need in comments.

Select Physical Damage Deductible:

$500 $1,000 $2,500 No Pysical Damage Coverage Desired

If You Need Cargo Insurance Please State Maximum Amount Required:

What Is The Maximum Cargo Value Actually Hauled?

What Are The Commodities Hauled?

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Comments:

Please indicate in comments if you would like a general liability quote as well.

Submit For A Quote:

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Shipman Insurance Agency
301 Hwy 80 W
White Oak, TX 75693
United States
ph: 903-297-4456
fax: 903-297-5802
alt: 800-779-2964
tshipman@shipmaninsuranceagency.com

Shipman Insurance Agency

Truck Quote Form

If you have questions feel free to call us at: 800-779-2964 or 903-297-4456

Please complete the form below as fully as possible.