Dealer and Service Insurance Questionnaire Please enable JavaScript in your browser to complete this form.Owner's Name: *Business Name (Including DBA): *Phone Number: *Email: *Mailing Address *City, State Zip *Garaging Address: *City, State Zip: *Business Status: *IndividualCorporationPartnershipLLCDo You Have Insurance? *Yes, I am currently InsuredNo, I am not currently insuredI have never been insuredName of Current or Prior Insurance *If you do not have current or prior insurance please enter N/AKind of ServiceRetailWholesaleServiceCheckboxes *NoneAlarmPost and ChainFully FencedPartially FencedWhat Limits of Liability Would You Like?100,000$500,000$1,000,0001x2x3xHow Much Inventory Do You Have (Dollar Amount)?Repair Shop: *YesNoIf Yes, What is Your Specialty? *If no please enter N/ADo you have a Tow Truck or Car Hauler? *Are You Involved In Car Racing? *How Many Dealer Plates Do You Have? *Maximum Number of Vehicles On The Lot? *Average Value of Vehicle: *Maximum Value of Vehicle: *How Many Years in Business? *How Many Years at Current Location? *Driver 1 - Drivers Name: *Driver 1 - Date of Birth: *Driver 1 - DL Number: *Driver 1 - Tickets or Accidents in the Past 3 Years? *Drivers 2 - Name: *Driver 2 - Date of Birth: *Driver 2 - DL Number: *Driver 2 - Tickets or Accidents in the Past 3 Years? *Are Any Vehicles Driven Home or For Personal Use? *YesNoSubmit