Garage Keepers Insurance Quote

Business Name *

(DBA) Doing Business As (not required)

Type of Business *

Federal EIN (not required)

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

Garage / Shop Address *

Mailing Address (if different) (not required)

Years in Business (not required)

Years of Experience in This Field (not required)

Estimated annual gross sales ($) *

Description of Operations (what kind of work you do) *

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

Tire shop: do you sell new and/or used tires? (check all that apply) *

New tires Used tires We do not sell tires (repair/service only)

About what percent of tire sales are USED tires? (not required)

Do you sell or install any tire manufactured MORE THAN 6 YEARS before the date of service? *

Yes No

Do you sell or install any tire manufactured more than 10 YEARS before the date of service? *

Yes No

Annual gross receipts for tire sales or installation, including wheels/rims $ *

% of total tire receipts by tire type (must total 100%) (not required)

All boxes together must total 100%

	New	Used	Recapped / retreaded / regrooved	Total
Private passenger (pickup, sedan, SUV, van)	Private passenger (pickup, sedan, SUV, van): New (%)	Private passenger (pickup, sedan, SUV, van): Used (%)	Private passenger (pickup, sedan, SUV, van): Recapped / retreaded / regrooved (%)	0%
Commercial truck, truck tractor or trailer	Commercial truck, truck tractor or trailer: New (%)	Commercial truck, truck tractor or trailer: Used (%)	Commercial truck, truck tractor or trailer: Recapped / retreaded / regrooved (%)	0%
Motorcycle, moped or scooter (street legal)	Motorcycle, moped or scooter (street legal): New (%)	Motorcycle, moped or scooter (street legal): Used (%)	Motorcycle, moped or scooter (street legal): Recapped / retreaded / regrooved (%)	0%
Off-road (ATV, golf cart, UTV)	Off-road (ATV, golf cart, UTV): New (%)	Off-road (ATV, golf cart, UTV): Used (%)	Off-road (ATV, golf cart, UTV): Recapped / retreaded / regrooved (%)	0%
Motorhome or camper	Motorhome or camper: New (%)	Motorhome or camper: Used (%)	Motorhome or camper: Recapped / retreaded / regrooved (%)	0%
Contractor, construction or farm equipment	Contractor, construction or farm equipment: New (%)	Contractor, construction or farm equipment: Used (%)	Contractor, construction or farm equipment: Recapped / retreaded / regrooved (%)	0%
Bus (16+ passengers)	Bus (16+ passengers): New (%)	Bus (16+ passengers): Used (%)	Bus (16+ passengers): Recapped / retreaded / regrooved (%)	0%
Other	Other: New (%)	Other: Used (%)	Other: Recapped / retreaded / regrooved (%)	0%
Subtotals	0%	0%	0%	0%

If you entered "Other" tire types, describe them (not required)

Do you create or manufacture recapped, retreaded or regrooved tires? *

Yes No

Do you reclaim, recycle or repurpose scrapped tires / rubber waste for anything other than use on a vehicle? *

Yes No

Gross receipts from scrapped tire / rubber waste reclamation, recycling or repurposing $ (not required)

Describe the reclamation, recycling or repurposing operations (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

Average number of customer vehicles on the premises at one time *

Maximum value of any one customer vehicle in your care *

Average value of a customer vehicle in your care $ (not required)

Maximum number of customer vehicles on the premises at one time (not required)

Maximum value of ALL customer vehicles on the premises at one time $ (not required)

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

Describe how you control customer keys (during and after business hours) *

Do you need to cover the building? *

Yes No

Do you own or lease the building? *

Own Lease

Building square footage *

Year built *

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

Roof type (not required)

Construction type *

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 now? *

Yes No

Who is your current insurance company? *

When does your insurance expire? *

When do you want your policy to start? *

Notes (not required)

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

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