Rainbow insurance brokers inc Rainbow Insurance Brokers Inc. 1101 Thompson Road East RR#5 Waterford Ontario 519.443.6113
online quote

Information Required for a Non-Fleet Quotation (Truck Insurance)
Business Name or personal name if not incorporated:
Address1:
Address2:
City:
Prov:
Postal Code
Phone:
Fax:
Cell Phone:
E-mail:

Please complete the following:
Number of years in the trucking business as an owner of at least one truck:
Current/Previous Insurer:
Renewal Date
Equipment description:
eg: 96 Freightliner Tractor, $100,000; 97 Stoughton Van Trailer, $35,000
Total percentage of miles in Canada and The USA.
Eg: 30% Canada/70% USA with a further breakdown by province and state with the totals equalling the 30%/70% ratio. (if business is not new - infor is obtained from Fuel Tax Reports, if new, best estimate is required)
Canada:
Provinces and percentages:
eg: 15%=ON; 15%=QC
USA:
States and percentages:
eg: 25%=NY; 25%=PA;10%=MA; 10%=OH
Driver Information:
Insert : driver(s) name;
age;
years of classified driving experience;
claim info for last 3 years (each driver);
demerits or suspensions for last 3 years
Claim Information:
(for this business or any trucking business that potential insured has owned in last three years)
Cargo Details: Owned Non-Owned
What limits:
($32,000 - $300,000 or more)
Type of Commodities:
(explain various types of cargo to be hauled)
Heating/Cooling Units

Yes No

Do you haul Hazardous Material or Dangerous Goods requiring placards Yes No
Do you have Operating Authority for Canada and/or USA Yes No

By pressing the submit button, you acknowledge that all information is true and accurate. Please take this time now to ensure that all info is correct. The best plan for you depends on the information that you send us.

By pressing the submit button you give permission to Rainbow Insurance Brokers Inc. to submit your information to various insurance companies in order to find an insurance plan that best fits your needs and your company's needs. All info you provide will only be used to find you the best plan.

 
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Rainbow Insurance Brokers Inc.
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