Auto Dealer Insurance Quote

Business Number (not required)

Date of Birth (needed to start your quote) *

Business Name (not required)

(DBA) Doing Business As (not required)

Driver License # (state next to it — OK is pre-selected) *

Federal EIN (not required)

Dealer License # (not required)

Will there be a second owner or salesperson? *

Yes No

Second Owner / Salesperson Name *

Second Owner / Salesperson Date of Birth *

Second Owner / Salesperson Driver License / State (not required)

Mailing Address (not required)

I'd like a quote for the following insurance products: *

Home Address (needed for the bond application) *

W-2 Employee Payroll Annually $ (for the Workers' Comp quote) *

1099 Subcontractor / Contract Labor Payments Annually $ (for the Workers' Comp quote) (not required)

When does your insurance expire? (not required)

When do you want your policy to start? *

Years Experience (minimum 2 years required) *

Driving Vehicles *

Furnished Auto: Personal & Business Use Unfurnished Auto: Business Use Only

Number of Dealer Plates *

Number of Other Types of Plates You Have (not required)

What percent of your auto sales are RETAIL? (%) *

What percent of your auto sales are WHOLESALE? (%) *

What percent of your auto sales are CONSIGNED? (%) *

Estimated annual gross sales ($) *

Do you share your premises with other business entities? *

Yes No

Do you have your own exterior door with no shared/common interior space? *

Yes No

Do you operate a salvage/dismantling lot? *

Yes No

Do you sell autos with a Certificate of Destruction Title? *

Yes No

Are repairs performed prior to sale? *

Yes No

Repairs: percent STRUCTURAL (%) *

Repairs: percent COSMETIC/MECHANICAL (%) *

Do you use a consignment agreement for consigned autos? *

Yes No N/A

Do you operate any auto pawn or title pawn operations? *

Yes No

Do you sell trailers (trailer dealer)? (not required)

Yes No

8. What is part of your dealer operation? (% of operation) (not required)

Total should equal 100%

	% of operation	Total
Private passenger autos	Private passenger autos (% of operation)	0%
Mobile homes	Mobile homes (% of operation)	0%
ATVs, snowmobiles, jet skis	ATVs, snowmobiles, jet skis (% of operation)	0%
Motorcycles	Motorcycles (% of operation)	0%
Tractors	Tractors (% of operation)	0%
Trailers	Trailers (% of operation)	0%
Motor homes	Motor homes (% of operation)	0%
Buses	Buses (% of operation)	0%
Contractor equipment	Contractor equipment (% of operation)	0%
Farm equipment / implement	Farm equipment / implement (% of operation)	0%
Internet sales of trailers	Internet sales of trailers (% of operation)	0%
Internet sales of parts/accessories	Internet sales of parts/accessories (% of operation)	0%
Other	Other (% of operation)	0%
Subtotals	0%	0%

19(a). Do you own and operate an auto transporter, tow truck, tank truck or tank trailer? (not required)

Yes No

19(b). Do you want coverage on them? (not required)

Yes No

Is this vehicle owned, leased or financed?

Finance / lease company name

Body type (pickup, tow truck...)

Garaged (city, state)

Physical damage deductible

Plate permanently attached?

Yes No

22(a). Do you sell tires? (not required)

Yes No

Tires: % of receipts (not required)

New tires % (not required)

Used tires % (not required)

22(b). Do you recap or retread tires? (not required)

Yes No

23. Do you install and/or repair trailer hitches or 5th wheel connections? (not required)

Yes No

% of operation (not required)

24. Do you hold a salvage dealer license or operate a salvage yard? (not required)

Yes No

25. Do you salvage cars for resale? (not required)

Yes No

26. Do you dismantle autos to resell parts? (not required)

Yes No

% of operation (not required)

27. Do you weld gas tanks? (not required)

Yes No

28. Do you repossess autos? (not required)

Yes No

29. Do you sell parts? (not required)

Yes No

Gross receipts from parts sold but NOT installed $ (not required)

Used parts % (not required)

New parts % (not required)

30(a). Do you spray paint at your business location? (not required)

Yes No

30(b). Do you use a UL-approved paint booth? (not required)

Yes No

31. Do you loan autos to customers? (not required)

Yes No

32. Do you rent autos to customers while their units are in for service? (not required)

Yes No

33. Do you furnish autos to anyone? (not required)

Yes No

34. Do you sponsor any racing events? (not required)

Yes No

35. Do you repair vehicles used for racing? (not required)

Yes No

Do you want Open Lot / Dealer Physical Damage coverage on your dealer's autos? *

Yes No

Lot Location (street, city, state, ZIP)

Maximum Value Per Auto $

Average Value Per Auto $

Average # of Autos on the Lot

Maximum Number of Autos on the Lot

Maximum Value of All Autos on the Lot $

Theft Protection at This Location

Other Theft Protection - Please Describe

Do you store autos away from the locations listed above? *

Yes No

If yes, where are they stored? *

Are the keys or any device used to start or operate the auto left in or upon the auto at any time? *

Yes No

Describe your key controls during normal business hours *

Describe your key controls after business hours *

Do you want Garage Keepers coverage on your customers' vehicles in your care? *

Yes No

Location (street, city, state, ZIP) *

Maximum Value Per Customer Auto $ *

Average Value Per Customer Auto $ *

Average Number of Customer Autos Stored at This Location *

Maximum Number of Customer Autos Stored at This Location *

Maximum Value of All Customer Autos Stored at This Location $ *

Theft Protection at This Location *

Other Theft Protection - Please Describe

Type(s) of work performed (check all that apply) (not required)

Do you perform any work at the customer's location or roadside (mobile service)? *

Yes No

Which work do you perform mobile? (check all that apply) *

Hours of operation for the MOBILE service (days and times, e.g. Mon-Sat 8am-6pm, 24/7 roadside) *

How many service trucks/vans are used for mobile service? (not required)

Do you want us to quote the mobile service vehicle(s) too? *

Yes No

Is this vehicle owned, leased or financed?

Finance / lease company name

Theft Protection / Security (check all that apply) (not required)

Do you need to cover the building? *

Yes No

Do you own or lease the building? *

Own Lease

Building square footage *

Roof age (years) or the year the roof was replaced *

Roof type (not required)

Building replacement cost value ($) *

Business personal property value: tools, lifts, equipment, inventory ($) (not required)

Number of stories (not required)

Number of service bays / lifts (not required)

Building protection (check all that apply) (not required)

Any updates to wiring, plumbing, HVAC or roof in the last 15 years? (what and when) (not required)

Do you do any spray painting or welding on the premises? *

Yes No

Is spray painting done in an approved paint booth? (not required)

Yes No

Are there other tenants or occupants in the building? *

Yes No

Any property losses in the last 5 years? *

Yes No

Describe the loss(es) and the amount paid *

Do you have coverage for this now? *

Yes No

Who is it with now? (not required)

When does that policy expire? (not required)

Any losses or claims in the past 3 years? (not required)

Yes No

Notes (not required)

How would you like us to contact you? (not required)

Upload your old policy (not required)

Up to 5 files total, 10 MB each — PDF, photos, or documents.

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