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Dealer With A Retail Lot

Call or Submit the Below Quick Form
770-974-0670 Office

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Complete Our Quick Form Below “DEALERS WITH A PHYSICAL LOT”

Dealer with a Physical Lot - Complete the Following (Industrial or Office Complex Lots Not Allowed)

Full Legal Name of Business including any DBA(Required)

Full Name(Required)

First Last

What is your TITLE with the company or tell us what your Relationship is to the company?(Required)

Primary Phone(Required)

E-mail Address(Required)

Mailing Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Number of Years in Business under Legal Name(Required)

Business Type(Required)

Dealership Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

What Type of Coverage Would You Like Quoted? Select All that Apply

Garage Liability

Garagekeepers

Workers Compensation

Umbrella for Higher Limits

Shop Contents

Shop Building

Cyber Liability

Employment Practices Liability Insurance (EPLI)

Do you operate an office from your physical lot?(Required)

Is the Lot fenced?(Required)

Do you share your lot premises with another business?(Required)

If yes, what business do you share your lot premises with? If no, type "NA."(Required)

Do you sell, rebuild, or repair autos with a salvage title?(Required)

Does your Dealership participate in any vehicle rental programs? Type "YES" or "NO"(Required)

Does your Dealership rent, lease, or loan vehicles to others? Type "Yes" or "No"(Required)

Does your Dealership participate in any vehicle rental programs? Type "YES" or "NO"(Required)

How Many Owners/Officers?(Required)

Any Inactive Officer(s) - List full name(s) or type "NA"(Required)

Number of Full-Time Clerical Employees or type "None"(Required)

Number of Part-Time Clerical Employees or type "None"(Required)

Number of Sales Persons or type "None"(Required)

Number of Full-Time Driver(s) or type "None"(Required)

Number of Part-Time Driver(s) or type "None"(Required)

Number of Mechanic(s) or type "None"(Required)

Number of Vehicle Washers/Detailers or type "None"(Required)

Number of Non Employees 1099 or type "None"(Required)

Number of Dealer Plates(Required)

Driver #1 Legal Name as appears on License(Required)

First Last

Date of Birth for Driver #1(Required)

Driver #1 Any violations, accidents or claims in 3 years(Required)

Driver #2 Legal Name as appears on License

First Last

Date of Birth for Driver #2

Driver #2 Any violations, accidents or claims in 3 years

Driver #3 Legal Name as appears on License

First Last

Date of Birth for Driver #3

Driver #3 Any violations, accidents or claims in 3 years

Driver #4 Legal Name as appears on License

First Last

Date of Birth for Driver #4

Driver #4 Any violations, accidents or claims in 3 years

(Please Note: If your Dealership does not have a "Physical Lot" located off of a main road, return to the Quote Screen and select Dealer Without a Lot. Sorry, industrial complex offices does not quality for this program as a lot.)

Do you employ additional drivers? If so, please send a list to [email protected](Required)

Anyone allowed to drive a Dealership vehicle home or after hours?(Required)

If someone drivers a Dealership vehicle home after hours, list name or names. If no one drives a Dealership vehicle home after hours, type "None"(Required)

Do you currently have a Garage Liability Policy?(Required)

Name of current Insurance Company or type None(Required)

Has there been a lapse in coverage in the last 3 years?(Required)

Has the Dealership had any claims in the past 36 months(Required)

What Liability Limit of Insurance do you want quoted?(Required)

Does Dealership offer Buy Here Pay Here?(Required)

Will you use your own money (Dealership money) to finance vehicles for customers?(Required)

Does the Dealership Lease or Rent Vehicles?(Required)

For the Owner - Do you have a personal insurance policy?(Required)

If the owner has personal insurance, list the carrier's name. If the owner does not have personal insurance, type "NONE"(Required)

Untitled

Do you need a Bond with your Liability insurance?(Required)

If you need a Bond with your Liability policy, we need your home address including City, State & Zip. If you don't need a bond, type "NA"(Required)

How did you hear about us? Please let us know(Required)

Is there anything else that you would like for us to know concerning your up and coming Renewal? ot type NA(Required)

SIGNATURE REQUIRED

I have provided all of the above information for insurance purposes and I state all information is true to the best of my knowledge. I also understand that I am to discuss with the agent at D. Ward Insurance my desired limits and coverage.

By typing my name warrants my signature.(Required)

First Last

ADDITIONAL INFORMATION NEEDED

After you have sumitted your quote request, we will start working on your quote and we will help assist with obtaining your claim history. The insurance carriers require us to show prior proof of coverage along with claim history. Thank you for your time and we will be in touch with you today unless this is after hours or on the weekend.

Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.

Dealer With A Retail Lot

Dealer with a Physical Lot - Complete the Following (Industrial or Office Complex Lots Not Allowed)

SIGNATURE REQUIRED

ADDITIONAL INFORMATION NEEDED

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