#
Lehman Insurance Agency
About Us
Carriers Represented
Home
Get A FREE Quote
Automobile
Boat
Condominium
Flood
Homeowners
Manufactured Homes
Motorcycle
Motorhome
Renters
Umbrella
Personal Insurance
Business Owners Policy
Workers Compensation
Property & Liability
Specialty Liability
Commercial Vehicles
Miscellaneous Commercial Insurance
Business Insurance
Life
-- Term Life Insurance
-- Permanent Life Insurance
Long Term Care
Financial Services
Make A Payment
Claims
Customer Service
Articles
Glossary
Links
Miscellaneous
Insurance Resources
Contact Us
 Trucking Quote 
Trucking Insurance Quote

Contact Information
Contact Name:
Day Telephone:
Business Name:
Eve Telephone:
Street Address:
Fax:
City, State Zip:
Best Time To Reach You:
E-Mail Address:
Company Information

Yes No

Yes No
Commodities Hauled
1.
2.
3.
4.
Total
100%
Tractors, Trailers & Straight Trucks
Type Year Make or Brand Physical
damage
coverage?
Radius of Operation
1
Enter Stated Value: $
VIN #
2
Enter Stated Value: $
VIN #
3
Enter Stated Value: $
VIN #
4
Enter Stated Value: $
VIN #
5
Enter Stated Value: $
VIN #
6
Enter Stated Value: $
VIN #
7
Enter Stated Value: $
VIN #
8
Enter Stated Value: $
VIN #
9
Enter Stated Value: $
VIN #
10
Enter Stated Value: $
VIN #
Check here if you have more than 10 Trucks, Tractors, or Straight Trucks; we will contact you for additional information.
Drivers(Including Owner-Operators)
Name of Driver #1 License
Number
License State Years
Experience
Date of Birth
1
# of Moving Violations # of Losses
or Accidents
Who have you been driving for in the past 3 years?
1
Name of Driver #2 License
Number
License State Years
Experience
Date of Birth
2
# of Moving Violations # of Losses
or Accidents
Who have you been driving for in the past 3 years?
2
Name of Driver #3 License
Number
License State Years
Experience
Date of Birth
3
# of Moving Violations # of Losses
or Accidents
Who have you been driving for in the past 3 years?
3
Name of Driver #4 License
Number
License State Years
Experience
Date of Birth
4
# of Moving Violations # of Losses
or Accidents
Who have you been driving for in the past 3 years?
4
Name of Driver #5 License
Number
License State Years
Experience
Date of Birth
5
# of Moving Violations # of Losses
or Accidents
Who have you been driving for in the past 3 years?
5
Check here if you have more than 5 Drivers; we will contact you for additional information.
Please explain any moving violations (date and type) and give dates of any accidents in the box below.
Coverages Required
Yes No
Yes No
yes no
Yes No
Yes No
yes no
yes no
Any additional comments or information that might
be helpful in your quote


No coverage of any kind is bound or implied by submitting information via this online form

  • Information from you and other sources, such as your driving, claims and insurance histories, may be used to calculate an accurate price for your insurance.
  • We will not distribute information to other parties other than for insurance underwriting purposes.
  • By submitting this form, you agree to release us from any liability should this information be accidentally viewed by others.

Manage Your Policy 
Auto ID Cards
Change of Address
Change of Name
Certificate of Insurance

Visit our online customer service center here.

Site Mailing List 

© Lehman Insurance Agency, 2007 Powered By: Insurance Web Designs