Garage Liability Quote Request

Garage Liability Quote Request

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Email(Required)

Business Name:(Required)

Business address (please list all locations):(Required)

If currently insured, please provide name of current carrier and expiration date of policy:

Number of years in business:(Required)

Description of operatsions:(Required)

Employee information (Please Provide: Name, Date of Birth, Drivers License Number, Job Title and Whether They are Full Time / Part Time):(Required)

Type of vehicles sold / repaired? Please provide percentages of each:(Required)

For non dealer operations, please provide types of repairs performed and percentages of each:(Required)

Are keys secured in lockbox or secure cabinet?(Required)

Yes

No

Accompany customers in the service / repair area?

Yes

No

If any spray painting, are operations confined to a UL approved booth?

Yes

No

If currently insured have their been any losses in the last 3 years?

Yes

No

If currently insured and you have had losses, please provide description of loss including date:

Coverage requested:(Required)

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