GARAGE OWNERS QUOTE REQUEST
Contact Information
1
 Contact Name:
Business Trade Name:
Mailing Address:
Address 2:
City - St - Zip:
Phone Number:       FAX
E-Mail Address:
2
 Years In Business:
3
 Years Sales/Repair Experience:
4
 Business Entity:
Individual
Partnership
Corporation
5
 Describe your Operations:
6
 Locations where you conduct Garage Operations: 
Location 1:
Location 2:
Underwritting Information List of Drivers (Owners, Employees, Family)
7
Name  
Drivers License State of License:
Date of Birth Furnished Auto:YES NO
Job Description and / or Relation: Past 3 Years Number of:
  Accidents :
Citations:
8
Name  
Drivers License State of License:
Date of Birth Furnished Auto:YES NO
Job Description and / or Relation: Past 3 Years Number of:
  Accidents :
Citations:
9
Name  
Drivers License State of License:
Date of Birth Furnished Auto:YES NO
Job Description and / or Relation: Past 3 Years Number of:
  Accidents :
Citations:
10
Name  
Drivers License State of License:
Date of Birth Furnished Auto:YES NO
Job Description and / or Relation: Past 3 Years Number of:
  Accidents :
Citations:
11
Name  
Drivers License State of License:
Date of Birth Furnished Auto:YES NO
Job Description and / or Relation: Past 3 Years Number of:
  Accidents :
Citations:
12
  
Name  
Drivers License State of License:
Date of Birth Furnished Auto:YES NO
Job Description and / or Relation: Past 3 Years Number of:
  Accidents :
Citations:
Sales
13
 Where do you purchase vehicles?
14 Who drives or tows vehicles to your lot?
15 How many times per year do you drive-away more than 300 miles from point of purchase?
16 How many vehicles do you sell per year?
17 How many of those are on consignment?
18 What is your normal radius of operation?
19 What is your sales mix?
a. cars, sport utility, pickups, vans
%
d. trucks, tractors, semi-trailers
%
b. motor homes % e. salvage parts %
c. travel trailers, camp trailers
%
f. other
%
20 Describe your theft barriers (fence & gate or post & cable)
21 Describe your key controls
22 How many dealer plates do you have?
23 Do you repossess vehicles? YES NO
If yes, explain
24 Do you sell "salvage titled" vehicles? YES NO
If yes, what percentage of vehicles require:
% cosmetic repair
% mechanical repair
% structural repair
25 Do you always ride along on test drives? YES NO
Services
26 What percentage of your work is:
Body/Paint % Muffler %
Tune Up % Radiator %
Transmission % Wheel Alignment %
Brakes % Oil & Lube %
Sound System
%
Window Tint
%
Tires % Upholstery %
Wash/Detail
%
Other
%
Describe:
27 Do you sell gasoline: YES NO
or LPG: YES NO
If yes, how many gallons:
28 Do you install trailer hitches? YES NO
29 Do you have a spray paint booth? YES NO
If yes, is it U/L approved? YES NO
Is it ventilated? YES NO
30 Do you recap tires or sell recapped tires? YES NO
31 Do you tow for hire? YES NO
If yes, explain
32 Describe lot security and key controls
Prior Carrier and Loss History for 3 Years
33 Current Carrier:
Policy Period:
Policy Premium:
34 Prior Carrier:
Policy Period:
Policy Premium:
35 Prior Carrier:
Policy Period:
Policy Premium:
36 Date of Loss:
Amount:
Description of Loss:
37 Date of Loss:
Amount:
Description of Loss:
38 Date of Loss:
Amount:
Description of Loss:
Coverage Requested
39
Garage Liability
$
 
Each accident $  
Aggregate, Deductible
$
 
40
(Legal Liab.) Garage-keepers
$ per location
 
SCL $ deductible  
Collision
$ deductible
  
41
Dealers Physical Damage
$ per location
 
SCL $ deductible  
Collision
$ deductible
  
42 Type: 
New
Used
43 Interests Covered: 
Owner
Owner and Creditor
Consignment Owner
44
Premises Medical Payments $1,000
Specifically Described Autos:
45
Veh.No. Year Make
Body Type
ACV
V.I.N.
46
Veh.No. Year Make
Body Type
ACV
V.I.N.
47
Veh.No. Year Make
Body Type
ACV
V.I.N.
48
Veh.No. GVW Radius
Use
Loss Payee   
49
Veh.No. GVW