Contact Information
(Step 1 of 10)
Company Name
Email Address
Phone Number
Next Step
Company Owner Information
(Step 2 of 10)
First Name
Last Name
Date of Birth
Marital Status
Select
Single
Married
Percentage Of Ownership
Drivers License Number
Drivers License Issuing State
Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Please summarize the company owner's experience in the ust/appliance/furniture delivery industry.
Will the owner be driving?
Select
No
Yes
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Company Information
(Step 3 of 10)
USDOT#
Federal Employer Identification Number
Mailing Street Address
Mailing City
Mailing State
Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Mailing Zip Code
Date DOT Authority Was Granted
Physical Street Address
Physical City
Physical State
Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Physical Zip Code
Company Type
Select
LLC
S-Corp
C-Corp
Years in Business
*If New Business, Input 0
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Operations Information
(Step 4 of 10)
Gross Annual Revenue Estimate
Primary City Of Operations
Zip Code Of Operations
Largest Cities Served
How many vehicles are you currently running?
All States Operated In
What is the zip code of the primary terminal you will be working at?
Average Length of Route (Miles)
Commodities hauled: Please select all that apply.
Furniture
Appliances
Building Materials
Exercise Equipment
Do you assemble furniture that is delivered?
Select
No
Yes
If you install appliances, please provide percentages below
% of appliances with no water AND no gas hook-ups?
% of appliances with water hook-ups?
% of appliances with gas hook-ups?
How many deliveries do you expect to complete each week?
Contract you deliver for on behalf of your Primary Contracting Carrier
Select
Conn's
Lowes
Wayfair
Ashley's Furniture
Peloton
Other
Additional Details
Are all vehicles registered and/or leased under your company name, or you as an individual?
Select
Company Name
Individual
Other
Additional Details
Which rental/leasing company do you use? If Applicable
Select
Ryder
Penske
Enterprise
Other
Additional Details
Do you perform work for any other contracting carrier?
Yes
No
Passengers transported (other than helpers)?
Yes
No
Additional Details
If you do lease or rent equipment, what is your estimated total cost per year for the lease?
Do you hire helpers and/or drivers?
Select
No
Yes
What is the expected payroll for your company this year?
Do you work, or plan to work for anyone other than UST?
Select
No
Yes
If yes, who?
Do you need workers compensation coverage?
Select
No
Yes, cover owner
Yes, exclude owner
Previous Step
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Insurance Information
(Step 5 of 10)
Do you have current insurance coverage?
Yes
No
What is the effective date of your insurance coverage?
Is your current insurance compliant with UST guidelines?
Select
No
Yes
Not Sure
Are you a new business/venture that is just getting started?
Select
No
Yes
If you are a new business/venture where are you in the insurance buying process?
Select
I've been talking to agents and have quotes in hand
I've been talking to agents but do not any quotes yet
I have not explored any insurance options yet
Have you ever been denied insurance coverage, or had coverage cancelled, during the past 3 years?
Yes
No
Additional Details
Loss History: I warrant that during the past five years no claims have been made against my insurance in the types checked below, nor am I aware of any situations that may result in a claim
Cargo
Auto
Workers Compensation
General Liability
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Safety Information
(Step 6 of 10)
Are drivers penalized for missing deadlines?
Yes
No
Are positive safety incentives (rewards, bonuses, etc.) offered?
Yes
No
Are safety meetings held regularly?
Yes
No
Additional Details
Do all employees complete mandatory safety training?
Yes
No
Any OSHA citations during past 12 months?
Yes
No
Additional Details
Do all vehicles display name/logo of your company?
Yes
No
Do you have a dedicated safety manager?
Yes
No
Additional Details
Is the company safety manual or procedures distributed to all employees upon hire?
Yes
No
If applicable, will you implement underwriter-recommended safety practices?
Yes
No
Previous Step
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Driver Hiring Information
(Step 7 of 10)
Written Application?
Yes
No
Formal Orientation?
Yes
No
Check Motor Vehicle Reports?
Yes
No
Interviewed in Person?
Yes
No
Written Test?
Yes
No
Drug and Alcohol Screening?
Yes
No
Background Check?
Yes
No
Physical Exam?
Yes
No
Check References?
Yes
No
Maintain Driver files?
Yes
No
Road Training?
Yes
No
Minimum Driver Age
Maximum Driver Age
Minimum Years of Related Driving Experience Required for Employment?
Previous Step
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Vehicle Information
(Step 8 of 10)
Owned, Rented/Leased
Owned
Rented/Leased
Vehicle 1
Delete
Year
Select
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
Make
Model
Vehicle Identification Number
City Where Garaged
Type
Select
Straight/Box Truck
Tractor/Trailer
Private Passenger Vehicle
Pickup
Cargo Van
Stated Value
Cost New
Gross Vehicle Weight
Select
Light Duty (< 10,000 lbs)
Medium Duty (10,001 - 26,000 lbs)
Heavy Duty (> 30,000 lbs)
Zip Code Where Garaged
Add Vehicle
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Driver Information
(Step 9 of 10)
Driver 1
Delete
First Name
Last Name
Date Of Birth
Marital Status
Select
Single
Married
Are you a driver, helper, or both?
Select
Driver
Helper
Both
Related Years Experience
Date Of Hire
Driving License Number
Issuing State
Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Add Driver
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Upload Documents
(Step 10 of 10)
Please provide the following documents related to the underwriting process:
Loss/Claim Reports (Loss Runs) from past 5 years (if applicable)
Company Owner Resume
MVRs for drivers (if available)
Allowed File Types: .pdf,.doc,.xls,.jpg,.gif,.docx,.xlsx
Maximum total size of attachments must not exceed 99MB. Please reduce/remove attachments and try again.
There are invalid files attached. Please remove invalid files and try again.
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