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Used Car Dealer Application Form
Processing...
Step 1 of 3
Proposed Policy Period: From:
To:
Named Insured:
DBA:
Mailing Address:
City:
County:
State:
Zip Code:
Phone:
Internet Address (If any):
FEIN:
Inspection/Audit Contact Name and Telephone Number:
Years in Business:
Years Sales/Repair Experience:
Have you ever operated a garage business under another name?
Yes
No
If yes, explain
Are you a licensed auto dealer?
Yes
No
Dealer Licence Number:
License Type:
Retail
Wholesale
Auto Broker
Other
Locations/Premises where you conduct Garage Operations:
1:
2:
Do you own or lease Location 1?
Own
Lease
Do you own or lease Location 2?
Own
Lease
Next
Step 2 of 3
What are your normal business hours?
Are autos stored at your premises after normal business hours?
Yes
No
If yes, describe your theft barriers/storage at each location for autos you OWN
(building, fence and gate or post and cable):
Location 1:
Location 2:
If yes, describe your theft barriers/storage at each location for autos you do not OWN
(building, fence and gate or post and cable):
Location 1:
Location 2:
Do you have or maintain animals on your premises?
Yes
No
If yes, what types/breeds?
Are these animals:
N/A
Pets
Used for Security Purposes
Professionally Trained
Are warning signs posted?
N/A
Yes
No
Where are they kept during business hours?
4. Total Gross Receipts from:
All Vehicle/Equipment Sales: $
All Repair: $
Other Uninstalled Product Sales: $
Tow Truck Operations:
Previous
Next
Step 3 of 3
Describe your key controls during business hours:
After business hours:
If a key box is used, describe location of key box (in building or attached to autos):
Do you pick up or deliver autos not owned by you?
Yes
No
If yes, how many times per week?
What is the average and maximum radius traveled?
Do you tow for hire?
Yes
No
If yes, explain:
Who drives or tows vehicles to your premises?
Do employees use their own vehicles within the scope of their employment?
Yes
No
If yes, how many times per week?
What is the average and maximum radius traveled?
Do you obtain certificates of insurance from all sub-contractors utilized (transporters, etc.)?
N/A
Yes
No
Do you utilize unscheduled contract drivers?
Yes
No
If yes, do you verify that they have valid U.S. driver licenses?
N/A
Yes
No
How many per: Week:
Month:
Year:
Do you loan or lease autos to others?
Yes
No
Do you loan autos to customers while their auto is being repaired?
N/A
Yes
No
If yes, provide copy of agreement.
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