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There are 5 slots for trucks and trailers, but please provide only as many as you need to endorse.
Be sure to provide all the valid information, to ensure the endorsement is a valid request.
Insured Information
Truck Information
1)
2)
3)
4)
5)
Trailer Information
* Note: For Non-Owned Trailers, input "Non-Owned" in the Make cell(s)
Policy Information and Other Information
Vehicle Documentation
To ensure the endorsement is processed rapidly, please ensure that valid registration is attached for this endorsement, along with any lease agreements or important documentation for each vehicle. Be sure to provide all the valid information, to ensure the endorsement is a valid request.
By submitting this form, I acknowledge and agree to the following:
I am an authorized representative of the entity named in the Insured Name field and understand that impersonating an authorized representative is subject to legal action.
The endorsement requested is not effective until confirmed in writing by my insurance agent or company.
Submission of this form does not imply immediate effectiveness of the endorsement.
Any ambiguities related to this submission will be resolved at the discretion of an authorized Roadways Representative.
Thank you for your submission! We will get back to you shortly via e-mail.