Commercial Trucking Quote | Merlo Insurance

General Information
Name:*
Legal Name of Business:
Address:
Street Address Address Line 2 City State ZIP Code
Business Phone:*
Email:*
Are You Currently Insured?:
- Yes
- No
Current Insurance Information
Insurance Company Name (not agency):
Policy Expiration Date:
Month
Day
Year
Years Insured:
Premium Amount:
Policy Term:
- 6 Months
- 1 Year
Truck/Motor Carrier Information
Truck Year:
Truck Make:
Truck Model:
Truck Value:
Driver Information
Date of Birth
Month
Day
Year
Years Driving Experience:
Number of Violations in the Last 3 Years:
Any Claims in the Last 3 Years?
- Yes
- No
Describe Any Claims You've Had in the Past 3 Years:
Additional Comments or Questions
Phone
This field is for validation purposes and should be left unchanged.