Call Us 770-974-0670 ☰ ˟
Logo
dward@dwardins.com      Call Us: 770-974-0670
  • Home
  • Get A Quote
  • About Us
    • About D.Ward Insurance Services, Inc.
    • Testimonials
    • Blog
    • Location Map
    • Employee Directory
    • Partners
    • Privacy Policy
  • Customer Service
    • Customer Service Forms
    • Payments
  • Resources
    • Insurance CoverageImage of right arrow
      • Auto and Homeowners Insurance
      • Life/Disability
      • Restaurant Liquor
      • Garage/Dealerships
      • Church/Childcare
      • Contractor/Workers Comp
      • Business Insurance
      • Bonds
      • Renters
      • Watercraft & Boat
      • Personal Umbrella Insurance
    • Secure Area
    • Refer a Friend
    • Important Links
    • Free Reports
    • Insurance Glossary
    • Frequently Asked Questions
  • Contact
    • Contact Us
    • Join our Newsletter

Auto
&
Home

Get a Quote

Life
& Disability

Get a Quote

Restaurant & Liquor

Get a Quote

Garage & Dealership

Get a Quote

Business & All Other

Get a Quote

Umbrella

Get a Quote
Home > Business > Repair Shops
Secured by SSL

Repair Shops



D. Ward Insurance Services, Inc since 1988 Office 770-974-0670


  Multiple Carries Will Compete
Our Agents know your business

 

  REPAIR SHOP APPLICATION



REPAIR SHOP INFORMATION
Full Legal Name of Business including any DBA *
First Name *
Last Name *
What is your TITLE with the company or tell us what your Relationship is to the company? *
Primary Phone Number *
E-Mail Address *
Mailing Address *
City *
State *
ZIP / Postal Code *
Number of Years in Business under Legal Name *
Business Type *




If Corporation or LLC, Federal ID# Required or if Sole Proprietor SSN Required *
Street Address of Repair Shop *
City *
State *
ZIP / Postal Code *
Type of Garage *


Is the Garage Operation located at a Home? *

Do You Own the Building? *
Approximate Age of Building *
Type of Construction *






Approximate Sq. Footage of the garage-occupied area *
What Type of Coverage Would You Like Quoted? Select All that Apply







How Many Bays are at your Shop? *
Where are the Vehicles Stored After Hours? *
What Type of Repair Work is Being Performed? *
What Type of Vehicles are you Working On? *
Any Major Engine Repairs? *

Any Frame Work Performed? *

Do you share your lot premises with another business? *

If yes, what business do you share your lot premises with? If no, type "NA." *
Do you sell, rebuild, or repair autos with a salvage title? *

Do you perform mobile repair services? *

Do you have a tow truck? *

If you have a tow truck, do you tow for hire? *


How Many Owners/Officers? *
Any Inactive Officer(s) - List full name(s) or type "NA" *
Number of Full-Time Clerical Employees or type "None" *
Number of Part-Time Clerical Employees or type "None" *
Number of Mechanic(s) or type "None" *
Number of Non Employees 1099 or type "None" *
Mechanic #1 Full Name as Appears on License *
Mechanic #1 Date of Birth as Appears on License *
Mechanic #1 License Number and State *
Mechanic #1 Any violations, accidents or claims in 3 years *

Mechanic #2 Full Name as Appears on License or Type "NA" *
Mechanic #2 Date of Birth as Appears on License or Type "NA" *
Mechanic #2 License Number and State or type "NA" *
Mechanic #2 Any violations, accidents or claims in 3 years or select "NA" *


Mechanic #3 Full Name as Appears on License or Type "NA" *
Mechanic #3 Date of Birth as Appears on License or Type "NA" *
Mechanic #3 License Number and State or type "NA" *
Mechanic #3 Any violations, accidents or claims in 3 years or select "NA" *


Mechanic #4 Full Name as Appears on License or Type "NA" *
Mechanic #4 Date of Birth as Appears on License or Type "NA" *
Mechanic #4 License Number and State or type "NA" *
Mechanic #4 Any violations, accidents or claims in 3 years or select "NA" *


Do you employ additional mechanics? If so, please send a list to dward@dwardins.com *

Do you sell vehicles or equipment? *

Do you allow customers to sell vehicles or equipment? *

Do you currently have a Garage Liability Policy? *

Name of current Insurance Company or type None *
Has there been a lapse in coverage in the last 3 years? *

Has the Repair Shop had any claims in the past 36 months *

What Liability Limit of Insurance do you want quoted? *
How did you hear about us? Please let us know *





If you selected "Other," tell us how you heard about us. *
Is there anything else that you would like for us to know concerning your up and coming Renewal?
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. *
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.
ENTER VALIDATION CODE
For Security of your personal information, enter code and press submit
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.

Secured by SSL
Insurance Websites Designed and Hosted by Insurance Website Builder

Contact Us Today!
770-974-0670

Social Social Social Social Social

Resources

  • Products
  • Customer Service
  • Payment Options
  • Report a Claim
  • News
  • About Us
  • Refer A Friend
  • Our Carriers
  • Blog
  • Contact Us

Contact Us

Mailing: 1720 Mars Hill Rd #8-185, Acworth, GA 30101
Physical: 3440 Blue Springs Road, #503j, Kennesaw, GA 30144

P: (770) 974-0670 | F: (770) 974-8577 |
E: dward@dwardins.com

© Copyright D. Ward Insurance. Serial No. 88558730. All rights reserved. | Powered by Insurance Website Builder