Leased Owner Operators Quote

Welcome to the Owner Operator Direct program for Leased Owner Operators! There are many factors that affect rates. Please provide all of the information requested below so that we may provide you with the lowest rate possible.

(* indicates required fields)

GENERAL INFORMATION
*Insurance Renewal Date:
*Motor Carrier's Name (Company you are leased to):
MC/DOT #:
Business Type:
If Individual/Sole Proprietor, enter dba (if you have one):
If Incorporated/LLC, enter legal business name:
*Your First Name:
*Your Last Name:
Suffix:
Email:
*Garaging Address:
*City:
*State:		*Zip:
*Mailing Address:
*City:
*State:		*Zip:
Home Phone:	- -
Business Phone:	- -
Cell Phone:	- -
Fax:	- -

VEHICLE INFORMATION
Tractor Year:	Tractor Make (No hotshot operations please):	*Tractor Value:
Trailer Year:	Trailer Make:	Trailer Value:

DRIVER INFORMATION
*Driver Name:
*Date of Birth:
License #:
*Years Experience (min. 2 yrs. required):
*Number of Moving Violations in the Last Three Years:
*Number of Accidents in the Last Three Years:
*Non-Trucking Liability Limit:
*Physical Damage Deductible:
*Cargo Hauled:
How would you like us to contact you?:
*How did you hear about us?:
* Note: Without providing MC/DOT#, you will only receive an estimate and not a final quotation. We do require that you are leased to a company and can provide your contract upon binding.

We will promptly deliver your quote to you via the method you selected above.

The completion of the application for insurance creates no express or implied obligation on the part of Lancer to offer a quote or provide insurance as requested.

An "electronic signature" means an electronic sound, symbol, or process attached to or logically associated with a record executed or adopted by a person with intent to sign the record.

By clicking on the "Submit Now" button below, you are acknowledging your signature to this application for insurance.

Lancer Insurance Company and its insurance affiliates use information collected from consumer reporting agencies such as your driving record and claims history in order to offer you the most appropriate rate. Please review our Privacy Policy.

Thank you for choosing Owner Operator Direct.