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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

Full Legal Name of Business including any DBA(Required)

Full Name(Required)
First Last
What is your TITLE with the company or tell us what your Relationship is to the company?(Required)

Primary Number(Required)
Email(Required)

Mailing Address(Required)
City State / Province / Region ZIP / Postal Code

Number of Years in Business under Legal Name(Required)
Business Type(Required)
Address of Repair Shop(Required)
Physical Location of Garage Address City State / Province / Region ZIP / Postal Code

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
Garage Liability
Garagekeepers
Workers Compensation
Umbrella for Higher Limits
Shop Contents
Shop Building
Cyber Liability
Employment Practices Liability Insurance (EPLI)
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)
First Last
Mechanic #1 Date of Birth as Appears on License(Required)
MM slash DD slash YYYY

Mechanic #1 License State(Required)

Mechanic #1 Any violations, accidents or claims in 3 years(Required)
Mechanic #2 Full Name as Appears on License
First Last
Mechanic #2 Date of Birth as Appears on License
MM slash DD slash YYYY

Mechanic #2 License State

Mechanic #2 Any violations, accidents or claims in 3 years
Mechanic #3 Full Name as Appears on License
First Last
Mechanic #3 Date of Birth as Appears on License
MM slash DD slash YYYY

Mechanic #3 License State

Mechanic #3 Any violations, accidents or claims in 3 years
Mechanic #4 Full Name as Appears on License
First Last
Mechanic #4 Date of Birth as Appears on License
MM slash DD slash YYYY

Mechanic #4 License State

Mechanic #4 Any violations, accidents or claims in 3 years
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)

Is there anything else that you would like for us to know concerning your up and coming Renewal?(Required)

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)
First Last
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.

Repair Shops

Repair Shop Application

SIGNATURE REQUIRED

ADDITIONAL INFORMATION NEEDED

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