Dealerships with a Lot

Dealer with a Physical Lot - Complete the Following
Industrial or Office Complex Lots Not Allowed
Full Legal Name of Business including any DBA Required
First Name Required
Last Name Required
What is your TITLE with the company or tell us what your Relationship is to the company? Required
Primary Phone Number Required
E-Mail Address Required
Mailing Address Required
City Required
State Required	AL GA NC SC TN
ZIP / Postal Code Required
Number of Years in Business under Legal Name Required
Business Type Required	Corporation Sole Proprietor Partnership LLC Other
If Corporation or LLC, Federal ID# Required or if Sole Proprietor SSN Required Required
Street Address of Dealership Required
City Required
State Required	AL GA NC SC TN
ZIP / Postal Code Required
What Type of Coverage Would You Like Quoted? Select All that Apply Optional	Garage LiabilityGaragekeepers Workers CompensationUmbrella for Higher Limits Shop ContentsShop Building Cyber LiabilityEmployment Practices Liability Insurance (EPLI)
Do you operate an office from your physical lot? Required	Yes No I do not have an office at my lot.
Is the Lot fenced? Required	8ft Fence with locking gate Pole Fence with locking gate No 8ft fence or poles
Do you share your lot premises with another business? Required	Yes No
If yes, what business do you share your lot premises with? If no, type "NA." Required
Do you sell, rebuild, or repair autos with a salvage title? Required	I do not work with salvaged vehicles Yes, I work with salvaged vehicles
How Many Owners/Officers? Required
Any Inactive Officer(s) - List full name(s) or type "NA" Required
Number of Full-Time Clerical Employees or type "None" Required
Number of Part-Time Clerical Employees or type "None" Required
Number of Sales Persons or type "None" Required
Number of Full-Time Driver(s) or type "None" Required
Number of Part-Time Driver(s) or type "None" Required
Number of Mechanic(s) or type "None" Required
Number of Vehicle Washers/Detailers or type "None" Required
Number of Non Employees 1099 or type "None" Required
Number of Dealer Plates Required
Driver 1 Legal Name as appears on License Required
Date of Birth for Driver #1 Required
Driver 1 License Number Required
Driver 1 Any violations, accidents or claims in 3 years Required	No known violation(s) for this driver Yes, this driver has violation(s)
Driver 2 Legal Name as appears on License or type "NA" Required
Driver 2 Date of Birth or type "NA" Required
Driver 2 License Number or type "NA" Required
Driver 2 Any violations, accidents or claims in 3 years or select "NA" Required	NA No known violation(s) for this driver Yes, this driver has violation(s)
Driver 3 Name as appears on License or type "NA" Required
Driver 3 Date of Birth or type "NA" Required
Driver 3 License Number or type "NA" Required
Driver 3 Any violations, accidents or claims in 3 years or select "NA" Required	NA No known violation(s) for this driver Yes, this driver has violation(s)
Driver 4 Name as appears on License or type "NA" Required
(Please Note: If your Dealership does not have a "Physical Lot" located off of a main road, return to the Quote Screen and select Dealer Without a Lot. Sorry, industrial complex offices does not quality for this program as a lot.)
Driver 4 Date of Birth or type "NA" Required
Driver 4 License Number or type "NA" Required
Driver 4 Any violations, accidents or claims in 3 years or select "NA" Required	NA No known violation(s) for this driver Yes, this driver has violation(s)
Do you employ additional drivers? If so, please send a list to dward@dwardins.com Required	No Yes
Anyone allowed to drive a Dealership vehicle home or after hours? Required	Yes No
If someone drivers a Dealership vehicle home or after hours, list name or names. If no one drives a Dealership vehicle home or after hours, type "None" Required
Do you currently have a Garage Liability Policy? Required	Yes, my garage has insurance No
Name of current Insurance Company or type None Required
Has there been a lapse in coverage in the last 3 years? Required	No, there has not been a lapse in coverage. Yes, there has been a lapse in coverage.
Has the Dealership had any claims in the past 36 months Required	No Claims during past 36 months Yes there are claim(s)
What Liability Limit of Insurance do you want quoted? Required	State Minimum to get started $300,000 $500,000 $1,000,000 Quote Umbrella
Does Dealership offer Buy Here Pay Here? Required	Yes No
Will you use your own money (Dealership money) to finance for customers? Required	Yes No
Does the Dealership Lease or Rent Vehicles? Required	Yes No
For the Owner - is there a personal insurance policy? Required	Yes, the owner has a personal insurance policy No, the owner does not have personal insurance
If the owner has personal insurance, list the carrier's name. If the owner does not have personal insurance, type "NONE" Required
Do you need a Bond with your Liability insurance? Required	Yes, I need a bond No, I don't need a bond I'm not sure
If you need a Bond with your Liability policy, we need your home address including City, State & Zip. If you don't need a bond, type "NA" Required
PLEASE LET US KNOW
How did you hear about us? Please let us know Required	Internet SearchGa Indep Auto Dealer Assoc (GIADA) Mailing from D. WardE-Learning Concepts Dealer Training A FriendOther
If you selected "Other," tell us how you heard about us. Required
Is there anything else that you would like for us to know concerning your quote request? Optional
SIGNATURE REQUIRED
I have provided all of the above information for insurance purposes and I state all information is true to the best of my knowledge. I also understand that I am to discuss with the agent at D. Ward Insurance my desired limits and coverage.
By typing my name warrants my signature. Required
ADDITIONAL INFORMATION NEEDED
After you have sumitted your quote request, we will start working on your quote and we will help assist with obtaining your claim history. The insurance carriers require us to show prior proof of coverage along with claim history.
Thank you for your time and we will be in touch with you today unless this is after hours or on the weekend.
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