Helpico Insurance Agency - Trucking Quote

"People hate insurance... But they hate worse the consequences of not having it. " Insurance Forum

"We still need to educate people on the need for insurance and help them through a process that is often more difficult than an online quote." Insurance Forum

"....today's prospects want to choose their own adventure in how they get to know a company, its products, services, and/or its team. So they (the company people) design discovery opportunities (blogs, demos, technology, samples, interactive experiences, etc.) that simulate a Disney ride when it comes to capturing attention and engaging the audience." ndoi.com

There was a very cautious man Who never laughed or played He never risked, he never tried, He never sang or prayed. And when he one day passed away, His insurance was denied, For since he never really lived, They claimed he never really died. (Anonymous poem)

Trucking Quote

Trucking Insurance Quote

Contact Information

Contact Name:		Day Telephone:
Business Name:		Eve Telephone:
Street Address:		Fax:
City, State Zip:		Best Time To Reach You:
E-Mail Address:

Company Information

Number of Years in Business
Effective Date Requested for Insurance
Are you permanently leased to a FHWA licensed carrier (bobtail coverage)? Yes No
For Hire FHWA Licensed Motor Carrier? (Do you haul under your own authority?) Yes No
If Yes - MC Number DOT Number

Commodities Hauled

1.
2.
3.
4.
	Total	100%

Tractors, Trailers & Straight Trucks

Type	Year	Make or Brand	Physical damage coverage?	Radius of Operation
1
Enter Stated Value: $			VIN #
2
Enter Stated Value: $			VIN #
3
Enter Stated Value: $			VIN #
4
Enter Stated Value: $			VIN #
5
Enter Stated Value: $			VIN #
6
Enter Stated Value: $			VIN #
7
Enter Stated Value: $			VIN #
8
Enter Stated Value: $			VIN #
9
Enter Stated Value: $			VIN #
10
Enter Stated Value: $			VIN #
Check here if you have more than 10 Trucks, Tractors, or Straight Trucks; we will contact you for additional information.

Drivers(Including Owner-Operators)

Name of Driver #1	License Number	License State	Years Experience	Date of Birth
1
# of Moving Violations	# of Losses or Accidents	Who have you been driving for in the past 3 years?
1
Name of Driver #2	License Number	License State	Years Experience	Date of Birth
2
# of Moving Violations	# of Losses or Accidents	Who have you been driving for in the past 3 years?
2
Name of Driver #3	License Number	License State	Years Experience	Date of Birth
3
# of Moving Violations	# of Losses or Accidents	Who have you been driving for in the past 3 years?
3
Name of Driver #4	License Number	License State	Years Experience	Date of Birth
4
# of Moving Violations	# of Losses or Accidents	Who have you been driving for in the past 3 years?
4
Name of Driver #5	License Number	License State	Years Experience	Date of Birth
5
# of Moving Violations	# of Losses or Accidents	Who have you been driving for in the past 3 years?
5
Check here if you have more than 5 Drivers; we will contact you for additional information.
Please explain any moving violations (date and type) and give dates of any accidents in the box below.

Coverages Required

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