Dealership Insurance Quote Request
Note: fields marked with an asterisk (*) are required.
Dealership Name *
Corporate Name *
Contact Person *
Business Type *
Corporation
Sole Owner
Partnership
LLC
DMV Dlr #
Type of License *
Wholesale Only
Retail
Mailing Address *
Mailing Address City *
Mailing Address State *
Mailing Address Zip Code *
Primary Location Street Address (if same as Mailing Address, write SAME)
Primary Location City
Primary Location State
Primary Location Zip Code
Secondary Location Street Address
Secondary Location City
Secondary Location State
Secondary Location Zip Code
Phone *
Fax
Cell / Other
E-mail address *
# of Owners *
# of Full Time Salesmen *
# of Part Time Salesmen *
# of Full Time Lot Boy / Mechanics *
# of Part Time Lot Boy / Mechanics *
# of Full Time Clerical *
# of Part Time Clerical *
Owner's Driver's License Number and State *
Owner's D.O.B. *
Owner Married *
No
Yes
Spouse Included *
Yes
No
Name of Spouse
Number of Children 14-21 Living at Home *
Time in Business *
Years Experience *
If in business less than three years, please list any related experience.
Time at Present Location *
# of Dealer Plates *
Current Insurance Agency (Required, if none enter 'None') *
Current Insurance Carrier (Required, if none enter 'None') *
Policy Expiration Date
Please explain ALL claims in the past four years (Required, if none enter 'None') *
Liability Limit *
$100,000
$300,000
$500,000
$1,000,000
What kind of cars do you sell *
Auto Inventory Value (Based on Dealer Cost) *
Avg. Cost per Vehicle *
Max Cost per Vehicle *
Avg. # of Vehicles *
Comp & Collision for Inventory *
No
Yes
Coverage for vehicles in your custody and control not owned by you?
Includes: Customer vehicles being driven by your employees to establish trade in value. Vehicles being road tested after repair. vehicles on consignment to you.
*
No
Yes
Take Cars on Consignment? *
Yes
No
Total Value of All Cars on Consignment?
Location Type *
Warehouse
Office
Outdoor Retail Lot
Wholesalers Home
Lot Protection Type *
None
Post & Chain
Wrought Iron
Chain Link
Warehouse
Alarm Type (If none, put 'None')*
Monitored
Local
None
Structure Coverage? *
No
Yes
Cost to Rebuild Bldg. (answer only required if requesting coverage)
Building Construction
Frame
Masonry
Metal
Contents Coverage? *
No
Yes
Value of Contents (answer only required if requesting coverage)
Landlord as Additional Insured? *
No
Yes
Sell Any Salvage? *
Yes
No
Sell More Than 5% Salvage? *
No
Yes
Buy, Sell, or Transport Vehicles Out of State? *
No
Yes
Own a Tow Truck? *
No
Yes
Tow Truck for Public Hire? *
No
Yes
Own a Tow Dolly/Tow Trailer? *
No
Yes
Premesis Shared with a Gas Station? *
No
Yes
Have Underground Tanks on Premesis? *
No
Yes
Rent Cars to the Public? *
No
Yes
Repair Cars for the Public? *
No
Yes
Have a Night Watchman? *
No
Yes
Anyone Live on the Lot? *
No
Yes
Have a Dog on the Lot? *
No
Yes
Firearm at the Lot? *
No
Yes
Buy or Sell via the Internet? *
No
Yes
Have Workers Comp Insurance? *
No
Yes
Source? *
Auction
Bing Search
Existing Client
Google Search
Magazine
Mailer
Referral
Yahoo Search
Tax ID # or SSN *
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