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Trucking Quote Form


The purpose of this questionnaire is to provide us with an overview of your business. Once received, one of our representatives will contact you as soon as possible to review the information and to obtain further details about your drivers and equipment. Submitting this form is only for the purpose of obtaining a no-obligation quote - it does not bind coverage.  Thank you!

GENERAL INFORMATION
Company Name
Required
First Name
Required
Last Name
Required
Street
Required
City
Required
State
Required
ZIP / Postal Code
Required
Primary Phone Number
Required
E-Mail Address
Required
ABOUT YOUR COMPANY
Type of Business
Required
Years in Business
Required
Annual Revenue
Required
Annual Mileage
Required
Commodities Carried
Required
MC #
Required
DOT #
Required
Percent of Operation Under 50 Miles
Required
Percent of Operation 51-300 Miles
Required
Percent of Operation 301-500 Miles
Required
Percent of Operation Over 500 Miles
Required
Major Cities Traveled To or Through
Required
Furthest State Traveled
Required
Travel in Canada?
Required
Number of Drivers
Required
Number of Employees OTHER Than Drivers
Optional
Number of Power Units
Required
Number of Trailers
Required
TYPE(S) of INSURANCE
What Type of Insurance Are You Looking For?
Optional



Expiration Date of Current Insurance
Optional
/ /
Name of Current Insurance Company
Optional
Describe Losses in the Past 5 Years
Optional
Submission Validation
Required
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Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages.  Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company.  If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.
HAPPY 4th of JULY!

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Lighthouse Group Main Office in Grand Rapids, MI
Mailing Address | P.O. Box 530009, Livonia, MI 48153

Phone: 734.421.9900 | Toll Free: 800.220.5582 | Fax: 734.421.9911

Also serving these Detroit area communities in Michigan: Livonia, Farmington Hills, Ann Arbor, Southfield, Plymouth, Canton, Westland, Northville, Novi, Dearborn, South Lyon & Walled Lake