Long-Haul Trucking Policyholder Exclusive Materials Order Form

Make sure your Lancer insured vehicles are equipped with this important claim procedure and reporting tool.

This reference tool provides invaluable information for documenting evidence at an accident scene.

This convenient card contains important phone numbers for reporting claims anytime,
day or night.

Please complete the order form below and indicate the quantity of the items you would like.

Name

First Name

Last Name

Company Name

Company Address

City

State

Zip

Emergency Procedures Visor Card - Enter Qty.

Taking Accident Scene Photo Instruction Card - Enter Qty.

Wallet Card - Enter Qty.