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Garage Application

Please complete the following application for a quote. All employees who work either full time or part time must be listed on the application - please use the Comments section at the bottom to add additional employees.

First Name *

Last Name *

Business Name

FEIN or Social Security Number *

Address *

ZIP / Postal Code *

Phone # *

E-Mail Address *

Website

Type of Business (LLC, Corp., Partnership, Individual, etc.) *

Years in Business *

Years of Experience *

Prior Carrier History? *

Any Losses? *

Any Insurance Cancellations or Declines (past 3 years)? *

Prior 12 Months Gross Income

Estimated Next 12 Months Gross Income?

Employee Name *

Employee Drivers License Number and State Issued *

Employee Date of Birth *

Violations/Accidents Prior Three Years? *

Does Employee Drive Cars Held for Sale? *

Does Employee Have Personal Auto Policy in Place?

Used Vehicles Sold Are: *

Hold down the Ctrl Key to make multiple selections.

Types of Sales: *

Hold down the Ctrl Key to make multiple selections.

Do You Have Security On Your Premises? *

Hold down the Ctrl Key to make multiple selections.

If Yes, What Type?

Hold down the Ctrl Key to make multiple selections.

Where Are Keys Kept During and After Business Hours? *

How Are Vehicles Transported To Lot When Purchased For Sale? *

Maximum Distance Traveled to Pick Up Vehicle For Sale? *

Do You Ride Along On Test Drives? *

Do You Always Obtain Copy of License and Insurance Prior To Test Drives? *

Do You Provide Buy Here/Pay Here Financing? *

Type of Coverage Desired? *

Hold down the Ctrl Key to make multiple selections.

Comments

Submission Validation

Required

Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.

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