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Real Estate – Resolute Capital
Insurance – Resolute Partners
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If referred, please enter the name or company.
How many trucks do you currently operate under your authority?
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1
2
3
4+
Upload Supporting Documents
Max. file size: 50 MB.
Year
Make
VIN
Value
Year
Make
VIN
Value
Year
Make
VIN
Value
Year
Make
VIN
Value
Year
Make
VIN
Value
Year
Make
VIN
Value
How many trailers do you currently operate under your authority?
*
1
2
3
4+
Upload Supporting Documents
Max. file size: 50 MB.
Year
Make
VIN
Value
Year
Make
VIN
Value
Year
Make
VIN
Value
Year
Make
VIN
Value
Year
Make
VIN
Value
Year
Make
VIN
Value
Do you need non-owned trailer coverage or trailer interchange?
Yes
No
What Value?
How many drivers do you currently operate under your authority?
Upload Supporting Documents
Max. file size: 50 MB.
Name
Date of Birth
Drivers License #
License State
Years of Experience
Date of Hire
What are your top three commodities hauled?
Coverages offered
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Select an industry
Liability Limit – drop down for $750,000 or $1,000,000 or other
Cargo Limit – drop down for $100,000 or $250,000 or other
Physical Damage - $500 or $1,000 deductibles
Non-Trucking Liability
General Liability
Workers Comp
Occupational Accident
Name of company you are leased to?
What is their DOT #
Upload Lease Agreement
Max. file size: 50 MB.
what is your FEIN #
Upload Lease Agreement
Max. file size: 50 MB.
Upload your loss runs here
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Max. file size: 50 MB.
Upload your ifta reports here
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Max. file size: 50 MB.
Upload your vehicle list here
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Max. file size: 50 MB.
Upload your drives list here
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Max. file size: 50 MB.
Upload safety materials here
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Max. file size: 50 MB.
Upload other supporting documents here
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Please provide a brief description about your company or anything else we should know.
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