Truck Quote Form

Truck Quote Request Form

Ararat Insurance Services
16256 Military Road S Ste #201
Seatac, WA 98188
Phone : 206-248-5615, Fax: (206)316-2176

Customer Name *

DBA

Address *

Phone *

Email *

Filings Needed?

DOT #

MC #

Misc

Do you Pull Doubles Triples?

Fixed Routes to Destinations?

Local Operation? (how many miles?)

Long Haul 48 States? (which states?)

Cargo Commodities: (what do you haul?)

Comodity

Percentage

Cargo Limit

Reefer Breakdown Needed? Yes/No

+ Add - Remove

Vehicle Information:

Truck or Trailer

Year *

Make *

Model *

VIN *

Stated Value: *

if Trailer: Type of Trailer

+ Add - Remove

Drivers Information

First and Last Name *

Date of Birth *

Drivers License # *

Yrs of Experience *

Year CDL was issued

Date of Hire

Add Remove

Coverage Requested:

Auto Liability *

UM / UIM

Personal Injury Protection (PIP)

Trailer Interchange (Limit)

Non Owned Trailer (Limit)

Comprehensive: (Deductible)

Collision: (Deductible)

Additional Notes:

Accidents *

YES

Please attach driving records and loss runs for the past 3 years; File Upload

Maximum upload size: 67.11MB