Application for Assistance

Trucker Down accepts applications for assistance through the web portal, email or US Postal Service. Applications are reviewed by the Board of Directors for Trucker Down to determine allocation of assistance to CDLA drivers or their family where appropriate. If a trucker tragically passes away as a result of an accident or medial issue while driving, Trucker Down is a resource for the families of these hard-working women and men. Further, Trucker Down is a resource for drivers that may be experiencing a personal hardship. These applications are also reviewed by the Board of Directors for Trucker Down to determine suitable support to keep our drivers healthy and on the road.

If you are a trucker/family of a trucker in need of assistance, please complete the form below

Assistance Form

Your Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Name of CDL Driver

First Name

Last Name

Date of Birth

Where did you hear about TruckerDown.Org

Are you a Veteran?

Yes

Issuing State / Driver’s License Number

(Please include a brief explanation if DL information is unavailable.)

Describe the circumstances of need and specific information on type of assistance requested

If you prefer to discuss your circumstance with someone at Trucker Down, please provide your contact information and a staff member will reach out to you directly by phone

Submission Agreement

Electronic submission of this application to TruckerDown.Org is deemed consent for TruckerDown.Org to conduct a Motor Vehicle Report (MVR) for the CDL number associated with the applicant seeking assistance. This information will be used only for the purposes of validating the status of the applicant's license and will not be shared further.

I understand

Printable Assistance Form

If you are a trucker/family of a trucker in need of assistance, please complete the form below

Friends & Partners