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TRS Fleet Application
Application for Commercial Fleets
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Agency Name
Producer Name
Effective Date of Coverage
Name of Applicant
Applicant Type
Individual
Partnership
Corporation
LLC
Other
US DOT Number
Federal ID Number
Street Address
City
ZIP Code
Phone
Name of Owner
Phone of Owner
Years in Trucking Industry
Business Start Date
Company has been under current management since
Has insurance been cancelled or non-renewed within the last 5 years?
Yes
No
Length of Haul (By % of Miles) > 0-50
Length of Haul (By % of Miles) > 51-200
Length of Haul (By % of Miles) > 201-500
Length of Haul (By % of Miles) > 501+
Description of Commodities > Commodity
Description of Commodities > % of Revenue
Description of Commodities > Avg. Value
Description of Commodities > Max Value
Historical Information > Term
Historical Information > Units
Historical Information > Revenue ($)
Historical Information > Mileage (#)
Name
*
First
Last
Email
*
Submit
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