Auto Dealer General Insurance Application

First Name:

Last Name:

Email:

Phone:

Select Type of Dealership:

Business Name:

DBA (Doing Business As):

Number of Locations:

Main Business Street Address:

City:

State:

Zip:

List All Other Business Addresses (Street, City, ST, ZipCode):

New or Current Business:

Number of Years in Business:

Number of Years Experience:

Involved in Auto Leasing or Rental Operations?*

Do You Import Automobiles?*

Do You Allow Overnight Test Drives?*

Offer Buy Here Pay Here?*

Do You Repose Vehicles?*

Do You Own a Tow Truck?*

If Yes, is Your Tow Truck Separately Insured?

Is There Any Other Business at Your Location?*

If Yes, Please Explain the Business:

Current Insurance Company (Current Dealers Only)

Current Insurance License # (Current Dealers Only)

Current Insurance Expiration Date (Current Dealers Only)

Any Claims in Past 3 Years? (Current Dealers Only)

Owner(s) & Employee Information (Mandatory to Include ALL Owners & Employees):
INCLUDE ON EACH LINE: Full Name, DOB, Drivers License (# and State) Job Position, Full Time or Part-Time

Anyone Drive Dealer Inventory Vehicles for Personal Use?*

Do All Licensed Owners/Spouses Have Private Autos in Their Own Names With Personal Auto Insurance Policies? *

Any Employee Who Will Be Driving Have ANY Tickets, Accidents, or Violations on Driving Record The Last 3 Years?*

If Yes, Who And What Tickets, Accidents, Or Violations?

How Many Dealer Tags Do You Have or Plan on Getting?*

How Many Transporter Tags Do You Have or Plan on Getting?*

Drive Coverage Radius for Pick-Up and Delivery?*

Do You Have Dogs at The Location?*

Do You Have Guns at The Location?*

Where Are Keys to Vehicles Kept?*

Where Are Vehicles at Your Location Stored? (Select All That Apply)*

Percentage (%) of Normal Automobiles You Sell (of all Sales 0 - 100%)?*

Percentage (%) of Commercial Trucks You Sell (of all Sales 0 - 100%)? *

Percentage (%) of Rebuilds You Sell (of all Sales 0 - 100%)? *

Percentage (%) of Antiques/Classics You Sell (of all Sales 0 - 100%)?*

Percentage (%) of Boats You Sell (of all Sales 0 - 100%)?*

Percentage (%) of RV’s You Sell (of all Sales 0 - 100%)?*

Percentage (%) of Motorcycle’s You Sell (of all Sales 0 - 100%)?*

Maximum Wholesale Cost of A Vehicle You Will Purchase?*

Maximum # of Vehicle Owned at Any One Time?*

Average Cost Per Vehicle?*

% of Retail Sales (of all Sales 0 - 100%)?*

% of Wholesale Sales (of all Sales 0 - 100%)?*

% of Consignment Sales (of all Sales 0 - 100%)?*

% of Exporting Sales (of all Sales 0 - 100%)?*

If You Sell on Consignment, What Is the Maximum $ Value of Any One Vehicle?

If You Sell on Consignment, What Is the Maximum # Amount of Autos?

If You Sell on Consignment, Will/Do You Have Consignment Agreements with The Owners?

If You Sell on Consignment, Are Consignment Vehicles to Be Included or Excluded in Coverages?

Limit of Garage Liability Do You Want/Need?*

Physical Damage Coverage $ Amount You Need:
(Should Equal At Least The # Of Vehicles Times the Average Cost Per Auto)?*

Do You Need Uninsured Motorist Coverage?*

Does a Landlord Need to be Listed as Additional Insured?*

If Landlord Needs to be Listed, Please Enter Landlords Full Name:

If Landlord Needs to be Listed, Enter the Square Footage of Building:

If Landlord Needs to be Listed, Enter the Limit of Coverage Landlord is Requesting:

Do You Use Floor Planning?*

If You Use Floor Planning, Whom Do You Use?

Comment or Message: