Garage/Garage Keepers - Auto & Dealers

Fill out the following form as completely as possible. Once you have completed the form, click the Submit button to send your information. Your request will be handled promptly.

How did you hear about us?

Where you referred to us?

Type of Quote Needed

Auto Dealers-Retail, Wholesale, or Broker?

Do you need a bond quote as well?

Garage Keepers-New or Used Parts?

Company Information

Company Name

First Name *

Last Name *

Owner Date of Birth

Driver's License#

Additional Owners Name, DOB, & DL

Street *

City *

State *

ZIP / Postal Code *

Is the mailing address and physical (garaging) address the same?

Primary Phone Number *

E-Mail Address *

Need to Purchase Coverage By?

How many years in business?

Do you currently have insurance?

Any claims within the last 3 years?

Coverage Amount

Employee Information

How many employees?

Full Time or Part Time?

Additional Driver(s) Full Name, DOB, Drivers License Number

Any violations or accidents in the last 3 years?

Property Information

Is the property fenced? If so, what is the height?

Burglar & Fire Alarm? Local or Central?

Any weapons on the property?

Any dogs and/or cameras on the property?

Some Underwriting Questions

Radius of Operations?

How many vehicles to you sell per year?

What's the maximum limit of any one auto?

What's the total value of vehicles on the lot at one time?

Are vehicles used for personal use?

Personal Auto Policy in place?

Additional Comments

Five Star Representative

Submission Validation

Required

Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.

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