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Repair Shops

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


 Multiple Carries Will Compete
Our Agents listen to the needs of your business

 

 

Repair Shop Application

Full Name(Required)
Mailing Address(Required)
Address of Repair Shop(Required)
What Type of Coverage Would You Like Quoted? Select All that Apply
Mechanic #1 Full Name as Appears on License(Required)
MM slash DD slash YYYY
Mechanic #2 Full Name as Appears on License
MM slash DD slash YYYY
Mechanic #3 Full Name as Appears on License
MM slash DD slash YYYY
Mechanic #4 Full Name as Appears on License
MM slash DD slash YYYY

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.


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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