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72-hour Liability & Physical Damage Coverage

Need temporary coverage for your truck? BTP offers 72-hour Non-Trucking Liability and Physical Damage coverage for qualifying risks. Complete the information below and our team will review your request and contact you to complete the coverage process.

Before you begin: Current CDL MVRs are required for all drivers, including the owner.

* indicates required fields

Name of Applicant*

Effective Date

Email*

Phone*

Mailing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Garaging Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

DOT#

Years In Business

Start Date

Start Time (AM/PM)

End Date

End Time (AM/PM)

Name of Owner

Phone

Address

Street Address Address Line 2 City State / Province ZIP / Postal Code

Please provide driver details. Current MVRs are required for all drivers, including the owner.

Name

DOB

License #

State

YOE**

**YOE – Years of Commercial Driving Experience

Please provide any violations / accidents within the last 3 years.

Name

Date

Violation/Accident Details

Please provide vehicle details, including any / all trailers to be covered.

Year

Make

Type

GVW

VIN

Value $

Do any of the vehicles or trailers listed above have any prior damage?

Yes

If yes, please specify vehicle/trailer and describe damage:

Please provide lien holder information

Name

Address

City

State

ZIP

File

Drop files here or

Max. file size: 49 MB.

This field is for validation purposes and should be left unchanged.