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Meinecke-Richards Agency, Inc
801 West Platt St, PO Box 1206
Maquoketa, Iowa 52060
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McAleer-Allen Insurance
Phone: 563-652-6994
Fax: 866-593-7850
Toll Free: 800-856-6995
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Online Quote Form
Truck, Trucking & Truckers Insurance Quote
Contact Name:
Business Name:
Street Address:
City, State & Zip:
E-Mail Address:
Telephone:
Fax:
Garage Address:
Owner/President:
Safety Manager:
Years in Business:
Other Manager:
Policy Information
Limits of Liability:
Inception Date:
Primary:
Deductibles:
UM / UIM:
Comp:
PIP / Medical:
Select..
Basic Limit
Increased Limit
Other
Coll:
GL:
Yes
No
Physical Damage:
Cargo Limit:
Tractor Values:
Terminal Address:
Trailer Values:
Hired Auto Required:
Yes
No
Policy Cancellation/Non-renewal last 5 years:
No
Yes
Operations
FHWA Docket #:
USDOT #:
Brokerage Name:
Docket #:
Brokerage/FF Revenue (this year):
Estimate for Next Year ($):
Current DOT Rating & Date:
Percentage of Radius of Operations
0-75:
301-500:
76-100:
500-1000:
Unlm:
Regular Routes:
Major Metro Areas:
Major Shippers:
Commodities Hauled
Commodity
% Hauled
Average Value
Maximum Value
Revenue/Mileage History
Yearly Estimates
Mileage
Revenue
# Units
For Year b/f last:
For Last Year:
For Coming Year:
Equipment
# Tractors
# of Trailers
# of Service Units
Owned:
O / O:
Add any additional comments or information that may assist us in your quote below:
Note: By submitting this form you understand that no coverage is bound until you receive written notice. You also agree to release us from any liability if this information is accidentally viewed by unauthorized persons. We will only use this information for insurance quoting purposes and not distribute to other parties.
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© 2012 Meinecke-Richards Agency, Inc