Skyline Insurance Services Pennsylvania residents call (570) 623-3000 New York residents call (800) 258-9404
Commercial Auto Insurance
Commercial Auto Insurance Quote
This application shall not be binding on the Underwriters unless and until a contract of insurance is issued and delivered in accordance herewith and then only as the commencement date of said insurance and in accordance with all terms thereof. The Applicant hereby covenants and agrees to and with the Underwriters that the foregoing statements and answers fully and truly represent, to the best of the Applicant's knowledge, all the facts and circumstances with regard to the risk to be insured. The Applicant also agrees that the answers and statements contained herein form the basis and conditions of the insurance.

The Applicant understands that the application can't be signed.
Company Information (*indicates required field)
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Driver Information
  Driver #1* Driver #2 Driver #3
Gender:







Birth Date:*    
Marital Status    
Drivers License #:    
License State:    
Social Security #:    
Have you had continuous liability insurance for the past 6 months with no more than a 30 day lapse?   
Additional Information
Number of Years in Business: *
Types of Cargo Hauled:
Type of Motor Carrier:
(a) Hauls own merchandise exclusively:
(b) Public Truckman
Common Carrier-Percentage:
Contract Carrier-Percentage:
List Cities Where Cargo Is Hauled
Is Filing To Be Made With The ICC?*
List of States Which Filings Are To Be Made:
Present Insurance Company:
Has any carrier cancelled or refused to issue or renew a policy?*
If Yes, list Company and why?
Terminal Exposure
Primary Address of Terminal:
Fire and Theft Precautions At Terminal:
Schedule of Equipment
   
Manufacturer: Vehicle 1:
  Vehicle 2:
  Vehicle 3:
  Vehicle 4:
Model: Vehicle 1:
  Vehicle 2:
  Vehicle 3:
  Vehicle 4:
Year: Vehicle 1:
  Vehicle 2:
  Vehicle 3:
  Vehicle 4:
VIN #: Vehicle 1:
  Vehicle 2:
  Vehicle 3:
  Vehicle 4:
Limit of Cargo Liability: Vehicle 1:
Vehicle 2:
Vehicle 3:
Vehicle 4:
Type of Insurance Desired
Standard Policy: fire, wind, collision, upset, collapse, flood?
Broad Policy: same perils as standard, plus theft of entire package?

Deductible Amount Desired?
Do you currently have other insurance policies/coverage with Skyline Insurance?
Additional Coverage
Are you interested in additional coverage? (Check all that apply)
Group Health Business Auto Business Property Workers Compensation
Insert Questions, Comments And/Or Additional Information Here: