Become an Agent

Interested in working with us?

Please complete the form below if you are interested in being an agent with Truckers Insurance Associates. Contact Sandi Filean, Compliance Manager with any questions at (800) 652-9515 (Extension #2974) or via email at


Download W-9


  • List all owners, officers, agents and contacts in the following departments: Licensing, Accounting, Claims, and Office Administration. You may also choose to attach a complete personnel list including title and contact details. These contacts will be utilized for any future communication needs.

    Click the (+) button to add a new contact.

    Name Department/Title Email Address Licensed? (Y/N)  
  • Max. file size: 64 MB.

  • Click the (+) button to add a new company.
    Name Type of Insurance Estimated Volume  
  • Please submit a copy of valid agency and agent(s) licenses for those states in which submitted business will be located.
  • Drop files here or

    Max. file size: 64 MB.

    • Request for Taxpayer Identification Number and Certification
      Max. file size: 64 MB.

    • Please note: We require a minimum limit of $1 million per occurrence/aggregate
      Drop files here or

      Max. file size: 64 MB.

      • Please provide the following information for those in your agency wishing to gain access to our website portal. Upon agency approval, each person will receive an e-mail with access instructions as well as username and password details. After your agency’s initial setup process, please e-mail Sandi Filean at to request the addition of others within your organization.
        Name Email Address Phone Number