Garage & Dealer Insurance

Complete and submit the following form to request a quote for garage and/or dealer insurance.

Business Name:
Contact Name:
Address:
City:

State:

Zip Code:
Phone:

Fax:
Email: REQUIRED TO SUBMIT FORM

EIN # or SS #:
 

Describe your business:

Building Value:

 $

  Contents Value:

 $

Loss of Income Value:

 $

 Liability Limits:

 $
Automobile Information

Number of drivers under the age of 21:

Number of accidents or convictions:

If yes, please explain:
Vehicle #1 Year: Make: Model: VIN #:
Vehicle #2 Year: Make: Model: VIN #:
 
Number of Employees:

  Payroll by class: 

   

Gross Sales by class: 

Do you provide towing service? Yes     No
If YES, do you tow for AAA? Yes    No
Average number of runs per week:
Number of Dealer tags:
Number of Salvage tags:
Number of Transport tags:
Number of customer vehicles on hand:
Value of each vehicle:

$
Number of vehicles sold monthly:
Average value per vehicle:

$
Average number of vehicles on sales lot:
Describe any losses in the last 3 years:
 
Additional comments or details: