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
Required
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| Last Name
Required
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| Business Name
Optional
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| FEIN or Social Security Number
Required
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| Address
Required
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| ZIP / Postal Code
Required
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| Phone #
Required
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| E-Mail Address
Required
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| Website
Optional
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| Type of Business (LLC, Corp., Partnership, Individual, etc.)
Required
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| Years in Business
Required
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| Years of Experience
Required
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| Prior Carrier History?
Required
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| Any Losses?
Required
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| Any Insurance Cancellations or Declines (past 3 years)?
Required
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| Prior 12 Months Gross Income
Optional
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| Estimated Next 12 Months Gross Income?
Optional
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| Employee Name
Required
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| Employee Drivers License Number and State Issued
Required
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| Employee Date of Birth
Required
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| Violations/Accidents Prior Three Years?
Required
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| Does Employee Drive Cars Held for Sale?
Required
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| Does Employee Have Personal Auto Policy in Place?
Optional
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| Used Vehicles Sold Are:
Required
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Hold down the Ctrl Key to make multiple selections. |
| Types of Sales:
Required
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Hold down the Ctrl Key to make multiple selections. |
| Do You Have Security On Your Premises?
Required
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Hold down the Ctrl Key to make multiple selections. |
| If Yes, What Type?
Optional
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Hold down the Ctrl Key to make multiple selections. |
| Where Are Keys Kept During and After Business Hours?
Required
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| How Are Vehicles Transported To Lot When Purchased For Sale?
Required
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| Maximum Distance Traveled to Pick Up Vehicle For Sale?
Required
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| Do You Ride Along On Test Drives?
Required
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| Do You Always Obtain Copy of License and Insurance Prior To Test Drives?
Required
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| Do You Provide Buy Here/Pay Here Financing?
Required
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| Type of Coverage Desired?
Required
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Hold down the Ctrl Key to make multiple selections. |
| Comments
Optional
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Submission Validation Required |
Enter the Validation Code from above.
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Important NoticeAny
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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