GET YOUR FREE INSURANCE QUOTE FROM John Hackney Agency Inc! Loss Runs are required (unless a new venture) Please provide the following: Name of Business Mailing Address Physical Address President / Owner Full Name (Inc. date of birth) Inception date of business FEIN/EIN – TAXPAYER ID Cell Phone Number Email address Drivers Name Class type (A, B or C) Date of Birth State of Licensure License Number State and Federal Filings DOT Number MC Number Radius (200, 300, 500 or unlimited) Power (Schedule of Autos) Units (MUST provide more than VIN #) Year Value Make Model VIN Cargo Commodities (Type and Percentage) List the top three commodities by name and percentage List top three commodities by percentage Do you need trailer interchange coverage? Yes Refrigerated Products coverage? Yes 67640