InstagramThis field is for validation purposes and should be left unchanged.Applicant InformationApplicant Entity Type:(Required) Individual Partnership Corporation LLC Joint Venture Other Applicant Name:(Required)Applicant's Name(Required) First Last Applicant's Company Name:(Required)(N/A if you don't have one)Owner's Name(Required) First Last Owner's DOB:(Required) MM slash DD slash YYYY Owner's Position(Required)Applicant's DOB:(Required) MM slash DD slash YYYY Applicant's Position(Required)What is the applicant's corporate name?(Required)(This is the name that goes on the tax returns)Business Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Is business address different than mailing address?(Required) Yes No Mailing Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Contact Person:(Required)Phone:(Required)Fax:Email:(Required) Web Address: FEIN (Tax ID #):(Required)Does the applicant have a DBA (Doing Business As) name?Do you operate at multiple locations?(Required) Yes No If yes, list all locations:(Required)In what year did the applicant start operations?(Required)2026202520242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900Is this entity a franchise?(Required)Applicant pays for the right to operate under the franchisor's brand and system, the franchisor being the one that owns the brand, products, and business model Yes No Describe what type of service(s) you provide (please describe in detail):(Required)Are there any locations or business interests that are owned by the applicant but not shown on the application?(Required) Yes No If yes, please describe in detail:(Required)Industry TypeSelect all that apply:(Required) New Auto Sales Used Auto Sales Auto Repair/Service Tire Sales & Service Towing Service Parking Garage/Valet Body Shop/Collision Repair Other Other (please specify):(Required)Business Operations & Coverage NeedsDo you have a dealer's license?(Required) Yes No Dealer's License Number:(Required)License expiration date:(Required) MM slash DD slash YYYY Dealer's License Photo Upload (optional):Max. file size: 50 MB. Do you perform vehicle repairs or maintenance?(Required) Yes No Do you offer towing services?(Required) Yes No Do you sell used or new vehicles?(Required) New Used Both Do you offer rental or loaner vehicles?(Required) Yes No Do you conduct repossessions?(Required) Yes No Do you conduct vehicle storage?(Required) Yes No Do you provide mobile repair services?(Required) Yes No Do you provide pick-up/delivery of customer vehicles?(Required) Yes No Do you own, lease, or rent the business premises?(Required) Own Lease Rent Are you involved in importing autos?(Required) Yes No Are you involved in public or livery passenger conveyance or on-demand delivery/courier services?(Required) Yes No Are you involved in any racing, race car preparations/repair, or race sponsorship?(Required) Yes No If yes, please describe:(Required)Do you have any hazardous exposures in your operations?(Required) Yes No If so, please describe hazard exposures in detail:(Required)Are jacks and car lifts stored in a protected area after work hours?(Required) Yes No Garage & Property DetailsNumber of locations:(Required)Garaging address(es) of locations:(Required) Add RemoveTotal square footage of garage/lot:(Required)Lot security measures:(Required)(Check all that apply) Fenced lot Security cameras Alarm system Security guards Other Other (please specify):(Required)Estimated number of customer vehicles on premises daily:(Required)Estimated value of all customer vehicles on premises at any time:(Required)Does the facility have a fire suppression system?(Required) Yes No On average, how many customer vehicles are in your care, custody, or control at any given time?(Required)Please enter a number greater than or equal to 0.What is the maximum number of customer vehicles in your care?(Required)Please enter a number greater than or equal to 0.What is the estimated average value of a single customer in your care?(Required)Please enter a number greater than or equal to 0.What is the maximum value of any single vehicle you handle?(Required)Please enter a number greater than or equal to 0.What is the aggregate total value of all customer vehicles you could have in your care, custody, or control at any one time?(Required)Please enter a number greater than or equal to 0.What are the primary reasons customer vehicles are on your premises?(Required)(e.g., repair, service, storage, parking, for sale on consignment)What security measures are in place for customer vehicles?(Required)(e.g., locked gates, fencing, surveillance cameras, security personnel, restricted access to keys)Do you require customers to sign waivers or disclaimers regarding vehicle damage?(Required)(Note: These may not hold up legally, but show intent)Sales Operations (for Dealerships)Are you a dealership?(Required) Yes No What types of vehicles are sold (e.g., new, used, passenger, commercial trucks, RVs, motorcycles)?(Required)What is the approximate average value and maximum value of a vehicle in your sales inventory?(Required)What is the average and maximum number of vehicles in your sales inventory at any one time? (This influences the "Dealers Physical Damage" or "Inventory" limit).(Required)What are the primary sources for acquiring used vehicles (e.g., trade-ins, auctions, wholesale)?(Required)Do you provide any financing or extended warranty products?(Required)Are demonstration drives offered?(Required) Yes No What are the policies for demo drives (e.g., driver license check, accompanying salesperson)?(Required)Do you lend vehicles to customers (loaners/service vehicles)? If so, how many, what type, and what are the customer qualifications?(Required)Garage Keepers CoverageDo you need Garage Keeper's Coverage?(Required)This is coverage for customer vehicles that are in your care, custody, and/or control. Yes No Type of Garage Keepers Coverage requested:(Required) Legal Liability Direct Primary Direct Excess Maximum number of customer vehicles on-site at any time:(Required)Please enter a number greater than or equal to 0.Average value per customer vehicle ($):(Required)Please enter a number greater than or equal to 0.Do employees drive customer vehicles?(Required) Yes No What is the capacity of the parking facility?(Required)Is it self-park or valet service?(Required)What are the security measures for the parking area?(Required)(e.g., attendants, cameras, controlled access)What are the procedures for handling keys for valet service?(Required)Employees & Driver InformationTotal number of employees who operate vehicles:(Required)Please enter a number greater than or equal to 0.Do you perform MVR (Motor Vehicle Record) checks?(Required) Yes No Do employees take customer vehicles off-site?(Required) Yes No Do you have a written vehicle safety policy?(Required) Yes No Are employees required to complete defensive driving courses?(Required) Yes No Do you employ minors who drive vehicles?(Required) Yes No Driver Information:(Required)Full Name / Date of BirthDriver's License #StateFT/PT# AccidentsHas Auto Policy? Add RemoveVehicle InformationPlease provide details of all applicant-owned business vehicles:(Required)(Attach separate document if needed)Year, Make, ModelVINGarage LocationUse Type (Service, Sales, Personal, Other)Estimated Annual MileageDrivers Assigned to Vehicle Add RemoveA document can be uploaded if you do not wish to provide vehicle information above.This document must contain information on each applicant-owned business vehicle, including: Year Make Model, VIN, Garaging Location, Usage Type (Service, Sales, Personal, Etc), Est Annual Mileage, Drivers Assigned to Vehicle) I want to upload a document instead Business Vehicle List - Document Upload:(Required)Max. file size: 50 MB. Insurance History & Loss ExperienceDo you currently have Garage Liability insurance?(Required) Yes No If yes, name of current insurer:(Required)Policy expiration date:(Required) MM slash DD slash YYYY Current coverage limits: Garage Liability:(Required)Please enter a number greater than or equal to 0.Garage Keepers:(Required)Please enter a number greater than or equal to 0.Other:Please enter a number greater than or equal to 0. Requested coverage limits: Deductible Preference:Please enter a number greater than or equal to 0.Covered Autos Liability:Please enter a number greater than or equal to 0.Limit Each AccidentGeneral Liability: Bodily Injury & Property Damage:Please enter a number greater than or equal to 0.Limit Each AccidentDamages to Premises Rented to You:Please enter a number greater than or equal to 0.Limit Any One PremisePersonal & Advertising Injury Liability:Please enter a number greater than or equal to 0.Any One Person/Organization LimitGeneral Liability:Please enter a number greater than or equal to 0.Aggregate LimitProducts and Work You PerformedPlease enter a number greater than or equal to 0.Aggregate LimitScheduled Autos: Coverage(s)(Required) Liability Specified Causes Comprehensive Collision Have there been any prior Garage or Commercial Auto claims, losses, or incidents (regardless of fault or of insurance paid) in the last five years?(Required) Yes No If yes, please provide full details including dates, descriptions, amounts paid, current status, and vehicle details if applicable:(Required)Has any previous Garage/Dealers insurance been declined, cancelled, or non-renewed?(Required) Yes No If yes, please explain the circumstances:(Required)Additional Notes & Special ConsiderationsAdditional Notes (Optional) Δ
