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Rivington Partners Transportation - Bind Request

* indicates required field

Bind Requirements:

• Completed Vehicle and Driver Spreadsheet
• Signed Rivington Application
• Signed UM/UIM coverage selection/rejection form
• Signed COE/Affidavit/Dilligent search form
• Any endorsement/exclusion that requires an insured’s signature
• Completed Quote
• Boxtruck Verification Form
• Authorization Form to Obtain Consumer Reports & Insurance Based Credit Score

Note:

If you scanned 2 or more documents into a single file, please upload the file into each of the corresponding form's upload link.

BIND

Bind: *

Auto Liability Only

Auto Liability & Physical Damage

Physical Damage Only (Liability Already Bound)

UPLOAD FILES

Upload Completed Quote *

Bind LIABILITY Option: *

A

B

Other Other

Upload PHYSICAL DAMAGE Quote *

Bind PHYSICAL DAMAGE Option: *

A

B

Other Other

Upload Vehicle and Driver Spreadsheet *

Upload Signed COE/Affidavit/Diligent Search Form *

Upload Signed Rivington Application *

Upload Signed UM/UIM Coverage Selection/Rejection Form *

Box Truck Verification Form *

Credit Authorization Form

Safety Discounts

Safety Discounts Applied

Safety Documentation

Upload Miscellaneous File 1

Upload Miscellaneous File 2

Upload Miscellaneous File 3

Upload Miscellaneous File 4

After clicking "Next", there might be a slight delay before the next page is displayed.

The files are being uploaded during the delay.