Torq Insurance Agency Quote Application

Enter your DOT number to auto-fill your carrier information. Complete all sections for an accurate quote.

Carrier

Coverage

Equipment

Documents

Submit

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Carrier Information

Enter DOT number to auto-fill your details

Business / Legal Name *

DBA Name

FMCSA Type

DOT Number *

MC / Docket Number

Contact Information

First Name *

Middle Name

Last Name *

Email *

Phone *

Business Details

Years in Business *🚀 New venture? Enter 0

Target Effective Date *

How Many Trucks? *

How Many Trailers?

Physical Address

Street Address *

City *

State *

Zip Code *

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Coverage Information

Select coverages and provide operational details

Coverage Requested *

Coverage Type

Insurance Limit

Desired Deductible

Commodities Hauled *

Commodity

Hauled %

Ave Load Value

Max Load Value

Estimated Annual Mileage

Estimated Annual Revenue

Operation Radius

0–500 Miles %

500+ Miles %

Average Radius

Maximum Radius

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Equipment & Drivers

List all drivers and units to be insured

Drivers *

Name

License Number

State

Date of Birth

Trucks / Tractors *

Year

Make

VIN

Value ($)

Owned/Leased

Trailers

Year

Make

VIN

Value ($)

Owned/Leased

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Documents

Upload your documents or let us contact you — we respond within 24 hours

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We move fast — during business hours we typically respond within the hour!

Upload your documents now for the fastest quote. If submitted after hours, we'll be in touch first thing the next business day. If you need help obtaining any documents, we've got you — we'll guide you through it.

Loss Runs 3 YRS MIN • 5 YRS PREFERRED

Loss runs show your claims history from your current or previous carrier. 3 years minimum, 5 years preferred — the more history we have, the better we can work on your behalf. Your carrier can provide these and we can help if needed. New venture with no prior insurance? No loss runs needed — just select the option below.

📤 Upload Loss Runs now 📞 I need help — contact me

IFTA Documents REQUIRED — LAST 4 QUARTERS

Your last 4 quarters of IFTA reports help verify your mileage and operating states. As a licensed carrier you already have these — check with your bookkeeper, accountant, or carrier portal. Brand new authority and haven't filed IFTA yet? No problem — just select the option below.

📤 Upload IFTA Documents now 📞 I need help — contact me

Current Insurance Declarations Page OPTIONAL

💡 Why this helps: Your current dec page lets us see exactly what coverage you currently have so we can evaluate it and place you with like or better coverage — making sure nothing falls through the cracks and you're fully protected.

📤 Upload Dec Page now ⏭️ Skip — Torq will follow up

Electronic Logging Device (ELD) REQUIRED

⚠️ Important: Several of our carrier partners require ELD information as part of the quoting process. Please select your ELD status below — you must answer this to proceed.

✅ Yes — we use an ELD ❌ No — we do not use an ELD ⚠️ ELD Exempt

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Authorization & Submit

Review authorization and submit your application

MVR Authorization (Required)

Company Requesting Report: Torq Insurance Agency LLC | Email: mike@torqinsurance.com

DISCLOSURE AND AUTHORIZATION

DISCLOSURE

The Company identified below ("Company") may obtain consumer reports regarding you from MVRcheck.com, a consumer reporting agency, for employment purposes in accordance with the Fair Credit Reporting Act (FCRA) and applicable law. These reports may include motor vehicle records (including CDL and FMCSA PSP records), county court traffic records, identity verification information, and other safety-related information obtained from public records or other lawful sources. MVRcheck.com does not make employment decisions and does not determine eligibility for employment.

AUTHORIZATION

I hereby authorize the Company to obtain consumer reports regarding me from MVRcheck.com. I understand that these reports may include motor vehicle records, county court traffic records, and other safety-related information. I authorize MVRcheck.com to furnish such reports to the Company. This authorization shall remain in effect for the duration of my engagement with the Company.

I confirm I have completed the MVR Authorization Form and authorize TORQ Insurance Agency LLC to obtain Motor Vehicle Records

📄 Current Insurance Declarations Page

A TORQ representative will be in contact with you to gather your current policy declarations documents.

⛽ International Fuel Tax Agreements (IFTA)

A TORQ representative will be in contact with you to gather IFTA documents.

📊 Loss Runs

A TORQ representative will be in contact with you to gather Loss Run documents.

By submitting this form, you agree to receive text messages from TORQ Insurance Agency LLC related to your insurance quote, policy updates, and other relevant information. Message and data rates may apply. Message frequency varies. Reply STOP to unsubscribe. Reply HELP for help.

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Application Submitted!

Thank you! Mike Alvarado at Torq Insurance Agency has received your application. During business hours we typically respond within the hour. If submitted after hours, we'll be in touch first thing the next business day!

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