Request A Quote | South Atlantic Insurance Services

Company Name

DOT#

First Name

Last Name

Street Address

City

State

Zip Code

Best Contact Number

Email

Equipment Year and Make

Total # of Trucks

1-5

6+ (Fleet Policy – An agent will contact you for additional information.)

Limits of Liability

Amount of Cargo Insurance

Type of Cargo Hauled

Building Materials / Heavy Equipment

Refrigerated Goods: Produce, meats, etc

Automobiles / Boats

Mobile Homes

Household Goods

Dry Goods: Grocery, Paper, Plastics

Target Items: Electronics, clothing, alcohol, shellfish

Other - Please explain

Radius

Have you had any paid claims in the last 36 months?

Yes No

Please check off any additional coverages required:

General Liability

Truckers Occupational

Trailer Interchange

Anticipated Date you will need this insurance

Where did you hear about us?

Questions or Comments