Logo Image For AIB Truck Insurance Louisiana - American Insurance Brokers, Inc. American Insurance Brokers, Inc.
69142 Highway 59, Suite A
Mandeville, LA 70471-7771
Toll Free: (800) 256-1177
Fax: (985) 871-1779
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In order to get the most accurate quote, please provide all of the information requested below. It is also important that you provide as much contact information as possible, so that our agency can easily get in touch with you with your quote or if we need additional information. Truck insurance coverage in Texas, Louisiana, Arkansas, Mississippi, Alabama, Georgia & Tennessee


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GENERAL INFORMATION
First Name:
Last Name:
Legal Business Name:
DBA:
DOT Number:
Address:
City:
State:
Zip:
(One phone required) Cell phone:
In order to avoid any delays in getting your quote or requesting additional information from you please provide an email and at least one phone number, or fax number.
Work phone:
Home phone:
Fax:
E-mail:
How do you wish to be contacted with your quote?:
DRIVER INFORMATION
Number of Drivers:
  If more than 5 Drivers, please email or fax the information requested below.
Driver’s
Name:

Years Driving Experience:

Date of
Birth:

No. moving violations
in the last 3 years:

No. accidents in
the last 3 years:

Driver’s
Name:

Years Driving Experience:

Date of
Birth:

No. moving violations
in the last 3 years:

No. accidents in
the last 3 years:

Driver’s
Name:

Years Driving Experience:

Date of
Birth:

No. moving violations
in the last 3 years:

No. accidents in
the last 3 years:

Driver’s
Name:

Years Driving Experience:

Date of
Birth:

No. moving violations
in the last 3 years:

No. accidents in
the last 3 years:

Driver’s
Name:

Years Driving Experience:

Date of
Birth:

No. moving violations
in the last 3 years:

No. accidents in
the last 3 years:

TRACTOR INFORMATION
Number of Tractors:
If more than 5 Tractors, please email or fax the information requested below.
1. Tractor
2. Tractor
3. Tractor
4. Tractor
5. Tractor
TRAILER INFORMATION
Number of Trailers:
If more than 5 Trailers, please email or fax the information requested below.
1. Trailer
2. Trailer
3. Trailer
4. Trailer
5. Trailer
COVERAGES NEEDED
Please indicate the Coverages 
you are requesting 
(check all that apply):
 Primary Liability Motor Truck Cargo Trailer Interchange Physical Damage General Liability Non-Owned Auto
Limits of Liability:
Amount of Cargo Insurance:
Type of Cargo being Transported:

 

If Other, please describe:

 

OPERATION INFORMATION
Radius of Operation:
 0-100 101-300 301-500 500+
What three (3) major cities
do you travel through?:


ADDITIONAL INFORMATION
  How did you hear about us?:


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*We look forward to working with you!

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American Insurance Brokers, Inc.    69142 Highway 59, Suite A    Mandeville, LA 70471-7771
Toll Free: (800) 256-1177    Fax: (985) 871-1779    info@aibtrucker.com   Sitemap