Used Car Dealer Application Form

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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?

If yes, explain

Are you a licensed auto dealer?

Dealer Licence Number:

License Type:

Locations/Premises where you conduct Garage Operations:

1:

2:

Do you own or lease Location 1?

Do you own or lease Location 2?

Step 2 of 3

What are your normal business hours?

Are autos stored at your premises after normal business hours?

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?

If yes, what types/breeds?

Are these animals:

Are warning signs posted?

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:

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?

If yes, how many times per week?

What is the average and maximum radius traveled?

Do you tow for hire?

If yes, explain:
Who drives or tows vehicles to your premises?

Do employees use their own vehicles within the scope of their employment?

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.)?

Do you utilize unscheduled contract drivers?

If yes, do you verify that they have valid U.S. driver licenses?

How many per: Week: Month: Year:
Do you loan or lease autos to others?
Do you loan autos to customers while their auto is being repaired?

If yes, provide copy of agreement.