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Oklahoma City, OK 73154
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Back to Express Requests
*Complete and submit the form below for an Express Premium Indication from OGA’s Small Business Unit
Fax: 405.840.9388 | 800.771.8116 Phone: 405.840.9393 | 800.299.1951
Please list each as: Commodity | Percentage of Loads | Maximum Value | Average Value
E.G.: Copper | 25% | $30,000 | $15,000
Describe the usual route(s) including largest city entered
Please list each as: Company Name | Policy Date | Policy Number | Premium | Number of Units
E.G.: Company X | 10/05/2011 | 121222 | $20,000 | 5 Units
Include 3 year history
If yes, Hired & Non-Owned supplemental form is required.
Will need non-driver payroll.
If yes, copy of Trailer Interchange Agreement is required.
Must be current market value
*Fully completed company specific applications and any applicable supplemental questionnaires are required prior to binding. The premium may change upon receipt of company applications and required supplementals.
If needed, please include any comments or additional information here.
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