Products and services offered by the Eck Agency may not be available in all states. This information shall not constitute an offer in any state in which a product or company is not properly registered or licensed. The Eck Agency generally offers and sells its products and services only in the states of Kansas and  Oklahoma. This information shall not constitute an offer in any foreign country.  All quotes are subject to underwriting and may not be available in all states.

4truckinsurance Quotes

The following information will be used to obtain an 
initial quote 
or call 1-800-444-4911 for a personal consultation
 
Business Name
Street Address
City
State
Zip 
Proposed Effective Date (mm/dd/yy)

Coverage Requested:

Liability Amount $750,000 $1,000,000 Other(please specify)
Physical Damage Deductible $250  $500  $1000
Cargo Amount
Type of Cargo usually hauled
Filings Required ICC MC#

Base State:

Annual Gross Receipts
Permanently leased or contracted to
Current Insurance Carrier
List Losses last three(3) years

Please provide the following driver information:

Number of drivers if more than 5 FAX
list to 1.620.254.7938
Driver 1
Name
Date of Birth (mm/dd/yy)    Yrs Exp.
# of Violations/Accidents
If no more drivers go to Trucks
Driver 2
Name
Date of Birth (mm/dd/yy)    Yrs Exp.
# of Violations/Accidents
If no more drivers go to Trucks
Driver 3
Name
Date of Birth (mm/dd/yy)    Yrs Exp.
# of Violations/Accidents
If no more drivers go to Trucks
Driver 4
Name
Date of Birth (mm/dd/yy)    Yrs Exp.
# of Violations/Accidents
If no more drivers go to Trucks
Driver 5
Name
Date of Birth (mm/dd/yy)    Yrs Exp.
# of Violations/Accidents
Go to Trucks

Please provide information on the trucks:

Number of trucks (if more than six fax list to 620.254.7938 with requested information)
Truck 1
Year
Make
Model

If No More Trucks Click Here
Truck 2
Year
Make
Model

If No More Trucks Click Here
Truck 3
Year
Make
Model

If No More Trucks Click Here
Truck 4
Year
Make
Model

If No More Trucks Click Here
Truck 5
Year
Make
Model

If No More Trucks Click Here
Truck 6
Year
Make
Model

If No More Trucks Click Here

How to contact you:

Work Phone
Cell Phone
FAX
Other Phone
    

Copyright © 2000 Eck Agency, Inc. All rights reserved.
Revised: April 30, 2008