Name: Karen & King Insurance
Address: 5051 Peachtree Corners Cir, Norcross, GA, 30092, US
Telephone: (404) 918-1459

GENERAL INFORMATION
Type
- NEW BUSINESS
- ESTABLISHED
BUSINESS NAME
DBA NAME
US DOT #
TAX ID #
MC #
DATE REQUIRED
MM slash DD slash YYYY
EFFECTIVE DATE
MM slash DD slash YYYY
YEARS IN BUSINESS
MAILING ADDRESS
Street Address City State ZIP Code
PHYSICAL ADDRESS
Street Address City State ZIP Code
CONTACT NAME
DOB
MM slash DD slash YYYY
YEARS EXP
EMAIL
PHONE
FAX
COVERAGES, LIMITS, DEDUCTIBLES, ADDITIONAL COVERAGES REQUESTED (CHECK ALL THAT APPLY)
COVERAGE
- AUTO LIABILITY
- PHYSICAL DAMAGE
- MOTOR TRUCK CARGO
- GENERAL LIABILITY
- TRAILER INTERCHANGE
- NON-OWNED PHYS
- EXCESS/UMBRELLA
- BOBTAIL coverage
LIST LIMIT & DEDUCTIBLE FOR EACH COVERAGE CHOSEN
COVERAGE LIMIT DEDUCTIBLE
ADDITIONAL COVERAGES REQUESTED
- UM/UIM/PD-STATE MIN
- MED-$5,000
- REEFER BREAKDOWN
- HIRED/NON-OWNED
- COMBINED DEDS
EST. ANNUAL MILEAGE
EST. ANNUAL REVENUE
ELD PROVIDER
AVG. RADIUS
MAX RADIUS
RADIUS
- UNLIMITED RADIUS
PERCENTAGE
0-50 MI. 50-200 MI. 200-500 MI. 500+ MI.
COMMODITIES HAULED
COMMODITY DESCRIPTION: % HAULED AVG. LOAD $ MAX LOAD $: SHIPPER
EQUIPMENT LIST - TRACTORS
YEAR MAKE VIN # TYPE VALUE ($) LOSS PAYEE
EQUIPMENT LIST - TRAILERS
YEAR MAKE VIN # TYPE VALUE ($) LOSS PAYEE
DRIVERS LIST
NAME DRIVER LICENSE # STATE DOB DOH YRS EXP
File Upload
Max. file size: 59 MB.
Download Forms
- FORM 1
- FORM 2
- FORM 3
Name
This field is for validation purposes and should be left unchanged.

COVERAGE	LIMIT	DEDUCTIBLE

0-50 MI.	50-200 MI.	200-500 MI.	500+ MI.

COMMODITY DESCRIPTION:	% HAULED	AVG. LOAD $	MAX LOAD $:	SHIPPER

YEAR	MAKE	VIN #	TYPE	VALUE ($)	LOSS PAYEE

Commercial Trucking Quote Request

GENERAL INFORMATION