Motor Dealer Services Insurance Quote Request

Dealership Insurance Quote Request

SSL encrypted for your protection.

page 1 - 2 - 3 - 4

Note: fields marked with an asterisk (*) are required.

Using your browser's back button will cause you to exit the form, losing your data.
Please use these navigation buttons instead.

page 1 - 2 - 3 - 4

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). *
Current Policy Expiration Date
Please explain ALL claims in the past four years (required, if none enter NONE). *
Liability Limit *
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 *
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. *
Take Cars on Consignment? *
Total Value of All Cars on Consignment?

Note: fields marked with an asterisk (*) are required.

Using your browser's back button will cause you to exit the form, losing your data.
Please use these navigation buttons instead.

page 1 - 2 - 3 - 4

Type the following: For security purposes, please type the letters in the image.
Note: fields marked with an asterisk (*) are required.

Using your browser's back button will cause you to exit the form, losing your data.
Please use these navigation buttons instead.