Morgan, Trevathan & Gunn, Inc.
Phone: (800) 489-4684  or Fax (270) 527-6257

Quote Proposal Sheet For Trucking Operations

*Date:

*Name:
*Address:
*City: *State: *Zip:
*Phone#: Fax #:
E-mail:

Quote Needed for:

Truck Liability
$750,000 CSL
$1,000,000 CSL 		Motor Truck Cargo
$ Amt
$ Ded 		Worker's Comp
Fuel Bonds
General Liability
Non-Truck Liability
$300,000 CSL
$500,000 CSL
$750,000 CSL
$1,000,000 CSL 		Trk Phy Damage
$500 Ded
$1,000 Ded
$2,500 Ded 		Pass/Accident
Occ/Accident
Life/Health

Equipment List:

Year-Make-Full Serial # Value Radius of Operation
1)

2)

3)

4)

5)

6)

7)

8)

9)

10)

11)

12)

 

ICC Docket Number:
Years In Business:
For Hire: Private:
Filings Needed:
Reefer Breakdown:
Deductible $:
Commodities Hauled (by % of time):

If in KY, is truck garaged in city limits? Yes: No:
Major cities traveled to:

If permanently leased:

Name of Lease Company:
Address:
Phone #: Fax #:

Driver Information:

Driver Name 1) 2)
Date of Birth 1) 2)
Drivers Lic # 1) 2)
Soc. Security # 1) 2)
Yrs Experience 1) 2)
Tickets/Accident 1) 2)
Covered by W/C 1) 2)
Driver Name 3) 4)
Date of Birth 3) 4)
Drivers Lic # 3) 4)
Soc. Security # 3) 4)
Yrs Experience 3) 4)
Tickets/Accident 3) 4)
Covered by W/C 3) 4)
Driver Name 5) 6)
Date of Birth 5) 6)
Drivers Lic # 5) 6)
Soc. Security # 5) 6)
Yrs Experience 5) 6)
Tickets/Accident 5) 6)
Covered by W/C 5) 6)

Thank you for your time in submitting this insurance quote form. A representative from our agency will contact you as soon as possible.

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