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Name of Business

Business Address

Contact Person

Contact Number

Email Address

Year, Make, and Model of Truck

Vehicle Identification Number (VIN)

Mileage

Usage of the Truck

Value of the Truck

Desired Coverage Type (Liability, Comprehensive, Collision, etc.)

Coverage Limits

Deductible Amount

Additional Coverages (Cargo Insurance, Trailer Interchange, etc.)

Name of Driver(s)

Driver's License Number

Driving Record

Years of Driving Experience

Payment Method

Billing Frequency (Monthly, Quarterly, Annually, etc.)

Total Premium Amount

Policy Start Date

Policy End Date

Policy Exclusions and Limitations

Signature of Applicant

In today’s volatile landscape, failing to plan for eventualities leaves you and your business exposed to liabilities,