Merrill Insurance Agency

Commercial Truck Quote Request

1Contact

2Drivers

3Equipment

4Operations

5Coverage

6Documents

Business & Contact Information

Tell us about your trucking business. Fields marked * are required.

Takes about 10 minutes. Don't have everything handy? Fill in what you can — a Merrill agent will follow up within one business day.

Business / Company Name *

Your Name *

Title / Role

Phone Number *

Email Address *

Business Address (where trucks are garaged)

City

State

ZIP Code

How You Operate

Which best describes your operation? *

This decides which coverages you need, so we ask it first.

Business Details

USDOT Number

New authority? Enter it if you have it, or leave blank.

MC Number (if you have one)

Years in Business

Business Entity Type

Date Coverage Is Needed

Submitted By (rep)

Driver Information

Add everyone who will drive the insured trucks, including yourself.

Vehicle & Equipment

Details for each truck or trailer to be insured.

Operations & Cargo

How and where you run, and what you haul.

Primary Cargo Type

% of your loads

Secondary Cargo (if any)

% of your loads

Do you ever haul any of these? (check all that apply)

Hazmat (placarded loads) Intermodal containers / rail or port work Refrigerated (reefer) loads High-value freight (electronics, alcohol, tobacco, pharma, copper) Trailers owned by someone else (power-only / trailer interchange)

Where You Drive

About what share of your driving is in each range from home base?

Local (0–50 miles) %

51–200 miles %

Over 200 miles %

Should add up to about 100%.

Estimated Annual Miles (per truck)

States You Run In

Do your trucks cross into Canada or Mexico?

No Canada only Mexico only Both

Parking & Safety

Overnight Parking Location

ELD / Dash Cam Equipped?

Current Insurance & Coverage Needs

Your current policy, claims history, and what you're looking for.

Current Policy

Currently Insured?

Current Insurance Company

Current Annual Premium

Current Policy Expiration / Renewal Date

In the past 3 years, has any trucking policy been cancelled, non-renewed, or lapsed?

Claims History (past 3 years)

At-Fault Accidents

Violations (speeding, log book, etc.)

Cargo Claims

Any DUI / DWI in past 5 years?

Claims Notes

Coverage Requested

Desired Liability Limit

Preferred Deductible Range

Anything else we should know?

Supporting Documents

Upload what you have now — it speeds up your quote. Everything is kept private.

MVR (Motor Vehicle Record): please include an MVR dated within the last 30 days for each driver. Illinois drivers can request a driving record abstract from the Illinois Secretary of State; Indiana drivers can order an official driver record from the Indiana BMV.

Drag files here or tap to choose PDF, photos (JPG, PNG, HEIC), Word, Excel, CSV — up to 10 files, 10 MB each, 25 MB total

Check each item you're uploading now:

Missing something? No problem. Email anything you didn't upload to info@merrillagency.com. Put your company name and USDOT number in the subject line so we can match it to your quote. Please don't email Social Security numbers or bank account numbers.

Step 1 of 6

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Thank You — Your Quote Request Is In

A Merrill agent will call you within one business day. Questions now? Call (815) 230-1914.

Merrill Insurance Agency | (815) 230-1914 | info@merrillagency.com | www.merrillagency.comYour information is private and used only to quote your insurance.