New Venture Questionnaire

Named Insured*

The named insured is the business owner or legal entity

Effective Date of New Venture*

The date this New Venture started

FEIN# or Social Security #*

We must have either your Federal Employer Identification number or your Social Security Number

How long have you been driving tractor/trailer Units?*

What date did you first receive your Drilver License and in What State?*

Who did you drive for prior to becomming a new Venture?*

What did you haul prior to becoming a new venture?*

Provide your prior route*

What will your "future route" be?*

2000

What will you be hauling and for whom?*

Will the New Venture require financing of the operation?*

With whom will the new financing be?*

Are you applying for an ICC Authority with the Named Insured Above?*

When?*

Since you answered no, Who's authority will you use?

Do you expect to increase the number of vehicles within one year?*

How many and when?

HIRING PRACTICES AND VEHICLE MAINTENANCE

Describe you hiring practices

Describe your vehcile maintenance program*

Will you allow trip leasing?*

Will you allow team drivers?

Are family members traveling with you?*

Name relationship and name of family members who travel with you

What are your anticipated gross yearly receipts?*

What is your total yearly estimated annual mileage?*