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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
Required
Last Name
Required
Business Name
Optional
FEIN or Social Security Number
Required
Address
Required
ZIP / Postal Code
Required
Phone #
Required
E-Mail Address
Required
Website
Optional
Type of Business (LLC, Corp., Partnership, Individual, etc.)
Required
Years in Business
Required
Years of Experience
Required
Prior Carrier History?
Required
Any Losses?
Required
Any Insurance Cancellations or Declines (past 3 years)?
Required
Prior 12 Months Gross Income
Optional
Estimated Next 12 Months Gross Income?
Optional
Employee Name
Required
Employee Drivers License Number and State Issued
Required
Employee Date of Birth
Required
Violations/Accidents Prior Three Years?
Required
Does Employee Drive Cars Held for Sale?
Required
Does Employee Have Personal Auto Policy in Place?
Optional
Used Vehicles Sold Are:
Required


Hold down the Ctrl Key to make multiple selections.
Types of Sales:
Required


Hold down the Ctrl Key to make multiple selections.
Do You Have Security On Your Premises?
Required


Hold down the Ctrl Key to make multiple selections.
If Yes, What Type?
Optional


Hold down the Ctrl Key to make multiple selections.
Where Are Keys Kept During and After Business Hours?
Required
How Are Vehicles Transported To Lot When Purchased For Sale?
Required
Maximum Distance Traveled to Pick Up Vehicle For Sale?
Required
Do You Ride Along On Test Drives?
Required
Do You Always Obtain Copy of License and Insurance Prior To Test Drives?
Required
Do You Provide Buy Here/Pay Here Financing?
Required
Type of Coverage Desired?
Required


Hold down the Ctrl Key to make multiple selections.
Comments
Optional
Submission Validation
Required
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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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