Don Evans Insurance Agency | TRUCK Insurance Quote

Truck Equip, Home, Life, Health, Auto Insurance

Rec Vehicles, Mortgage Loans, Claims Info

TRUCK INSURANCE QUOTE
We provide insurance coverage for Minnesota and Wisconsin only

To obtain a FREE, no obligation quote for your Truck Insurance, fill out the form below and we will contact you. If you prefer to give information over the phone, fill out the * areas only and we will give you a call, or print this out and mail or fax it to us.

Name:

Address:

City:

State:

ZIP:

Home Phone:

Email:

Work Phone:

Cell Phone:

Present Truck Insurance Co:

Renewal Date:

Business Name:

Years In Business:

Social Security No:

TYPE OF BUSINESS ENTITY:

   Sole Proprietorship
   Partnership
   Corporation
   Limited Liability Corporation--

Please answer the following questions prior to proceeding through the quote form:
Do any of your vehicles go beyond a 300 mile radius of your mailing address? (If you answered yes to this question you will not fit into our timber programs and we will have a difficult time placing your coverage at a competive rate).	Yes No
Are the vehicles to be insured used 50% of the time or more for logging or timber purposes? (If you answered no to this question you will not fit into our timber programs).	Yes No
Can you provide us with a complete listing including drivers license number, date of birth, and full name for each employee who might operate your vehicles even if it is only on an occasional basis? (If you answered no to this question we will have a difficult time providing you with an accurate quote).	Yes No
Can you provide us with a complete listing including drivers license number, date of birth, and full name for each employee who might operate your vehicles even if it is only on an occasional basis? (If you answered no to this question we will have a difficult time providing you with an accurate quote).	Yes No

Operator information - please provide as much information as possible to assure accuracy on the quote. The information collected enables us to receive information from motor vehicle departments, consumer reporting agencies and inspection services. This information is available to the insurance companies who provide the quotes.

Operator 1 Name: Date of Birth:

Operator 1 Drivers License No:

Operator 2 Name: Date of Birth:

Operator 2 Drivers License No:

Operator 3 Name: Date of Birth:

Operator 3 Drivers License No:

Operator 4 Name: Date of Birth:

Operator 4 Drivers License No:

Operator 5 Name: Date of Birth:

Operator 5 Drivers License No:

Operator 6 Name: Date of Birth:

Operator 6 Drivers License No:

Do you have a current loss run or claims experience reports from your current insurer? Yes No
We can provide a quote based on your verbal disclosure of any prior claims but we cannot guarantee the rate or bind the coverage until we have documents indicating your loss experience for the three prior years.

What is the name and policy number of your current insurance company and when does your policy renew?

Do you haul products for others? Yes No This will not create a problem in our ability to quote your account but it can indicate that you may need to have filings with the state or federal government.

Do you need a filing with a government entity? If so please indicate particulars.

What is the current liability limit that you have on your policy?
$500,000. $750,000. to $1,000,000.

UNIT #1

Year: Make: GVW of the unit: Current Value: