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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
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
ZIP / Postal Code
Required
Number of Years in Business under Legal Name
Required
Business Type
Required




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


Is the Garage Operation located at a Home?
Required

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




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




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

Any Frame Work Performed?
Required

Do you share your lot premises with another business?
Required

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

Do you perform mobile repair services?
Required

Do you have a tow truck?
Required

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


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 Mechanic(s) or type "None"
Required
Number of Non Employees 1099 or type "None"
Required
Mechanic #1 Full Name as Appears on License
Required
Mechanic #1 Date of Birth as Appears on License
Required
Mechanic #1 License Number and State
Required
Mechanic #1 Any violations, accidents or claims in 3 years
Required

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


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


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


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

Do you sell vehicles or equipment?
Required

Do you allow customers to sell vehicles or equipment?
Required

Do you currently have a Garage Liability Policy?
Required

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

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

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



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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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.