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Business Name*

USDOT Number*

Contact Name*

Position*

Phone*

E-mail*

Estimated gross annual mileage for all units*

Estimated gross receipts for upcoming year*

Radius of travel*

List your cargo commodities*

What do you want to improve in your insurance program this year?

Are you completely satisfied with Colonial Insurance?*
YesNo

Are you or your drivers covered by occupational accident insurance?*
YesNo

How can we improve?

Would you like to get a proposal for occupational accident insurance?*
YesNo

Are you set up to use our 24/7 online certificate portal?*
YesNo

Do we insure all owned and operated vehicles under your authority?*
YesNo

List all trucks and trailers below. If list is too long, please attach vehicle list below.
Truck 1

Year

Make

VIN

Value

Type

Ownership

Truck 2

Year

Make

VIN

Value

Type

Ownership

Truck 3

Year

Make

VIN

Value

Type

Ownership

Truck 4

Year

Make

VIN

Value

Type

Ownership

Truck 5

Year

Make

VIN

Value

Type

Ownership

Truck 6

Year

Make

VIN

Value

Type

Ownership

Truck 7

Year

Make

VIN

Value

Type

Ownership

Truck 8

Year

Make

VIN

Value

Type

Ownership

Truck 9

Year

Make

VIN

Value

Type

Ownership

Truck 10

Year

Make

VIN

Value

Type

Ownership

Add another vehicle

List all drivers below. If list is too long, please attach driver list below.
Driver 1

Name

Date of Birth

License #

State

Years of CDL Exp.

Date of Hire

Driver 2

Name

Date of Birth

License #

State

Years of CDL Exp.

Date of Hire

Driver 3

Name

Date of Birth

License #

State

Years of CDL Exp.

Date of Hire

Driver 4

Name

Date of Birth

License #

State

Years of CDL Exp.

Date of Hire

Driver 5

Name

Date of Birth

License #

State

Years of CDL Exp.

Date of Hire

Driver 6

Name

Date of Birth

License #

State

Years of CDL Exp.

Date of Hire

Driver 7

Name

Date of Birth

License #

State

Years of CDL Exp.

Date of Hire

Driver 8

Name

Date of Birth

License #

State

Years of CDL Exp.

Date of Hire

Driver 9

Name

Date of Birth

License #

State

Years of CDL Exp.

Date of Hire

Driver 10

Name

Date of Birth

License #

State

Years of CDL Exp.

Date of Hire

Add another driver

Do you have dash camera systems installed in all of your trucks?*
YesNo

Do you have a trailer theft deterrent such as air cuff locks or heavy duty padlocks?*
YesNo

Do you need any help reducing safety scores?*
YesNo

Have there been any other changes to your operation?*
YesNo

Please explain...

Please attach up to last 4 quarters of IFTA reports and any additional files below. Maximum file size is 10MB.
If you have any additional questions or concerns -- please call us at (678) 733-3370!

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Attachment 4

Attachment 5

Attach another file

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9 Reasons Why We Should Be Your Truck Agent

  1. We believe in intergity, honesty and long-term business relationships. We think they are important to you as well – after all, we collect your premium dollars and you count on us in a time of need. We pledge to give you honest, straightforward answers to your questions.
  2. Our staff makes the difference – people don’t do business with companies, they do business with people. We are real people that live and work in the community just like you. We are not a faceless corporation or an online trucking insurance agency found on the internet.
  3. Our agents return calls and e-mails. It is inexcusable for anyone in the trucking insurance business not to return phone calls or e-mails. We provide streamlined trucking insurance to enable you to manage your business quickly and efficiently. No wasted time, no BS.
  4. We provide 24/7 online access to your certificates. We give you the tools to quickly manage your trucking insurance policy. We will be there when you need us.
  5. Safety services – your safety scores are directly related to the price you pay for your trucking insurance. If you are looking to save money – let us help you. We can show you how to improve your safety scores and address the root cause of your safety issues whether it is accident prevention, log books, vehicle maintenance or driver files.
  6. We give you firm prices and clear terms in our truck insurance policies. If we have made an error, we will try resolve it quickly and in your favor. We only ask that you are honest and straightforward with us about your operation.
  7. We know price is important to you – we bring value to your insurance program by marketing your renewal with our 20+ trucking insurance providers. No one else comes close to our access to truck insurance markets! In the event that you find a lower rate from another company, we will review it and give you our fair opinion even if it means that we will lose your business.
  8. We are here to answer your trucking insurance questions. Trucking is a complex and highly regulated business. Have a question about a driver MVR? Need $250,000 in cargo coverage for one trip? Just call or e-mail us. We don’t have all the answers, but we’ll try our best to find out.
  9. Small business is big business for us. We are a small, family-owned business just like you. We understand your problems and concerns. Small trucking fleets make up the majority of our business. We’ll work just as hard to cover the owner-operator as we will for the 20-unit fleet.

We can provide the following types of truck insurance:

primary liability
physical damage
motor truck cargo
occupational accident
workers compensation
general liability
broker bonds

Some coverage programs can include:

• Rates starting at $400/Month/Truck
• Mileage or Revenue Reporting Form
• 24/7 Access to Certificate of Insurance
• Profit sharing physical damage policies
• Complimentary DOT safety programs
• “A” Rated Insurance Companies

Ready to get started on your quote? We’d love to hear from you! Get In Touch