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Home > Garage Insurance > Dealer without a Lot Renewal Form
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Dealer without a Lot Renewal Form


Fill out the following form as completely as possible. Once you have completed the form, click the Submit button to send your information. Your request will be handled promptly.

DEALERSHIP WITHOUT A PHYSICAL LOT
OWNERS AND DRIVERS 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 your Dealer's Office *
City *
State *
ZIP / Postal Code *
Will the Dealership use any other location for storage of vehicles including any residence location? If so, type full address including city and zip code. If none, type "NONE" *
Number of Dealer Vehicle Plates *
Any other plates - other than for Vehicles? If none, type "NONE" or list # and type *
What Type of Coverage would you like quoted? Select all that appy







What Liability Limit of Insurance do you want quoted? *
OWNERS AND DRIVERS INFORMATION
In this section you will need Drivers License information including any violations for the past 36 months. If more than 4 individuals, please type a list and submit to DWard@dwardins.com and be sure to label with your Dealership's name.
Number of Owners/Partners/Officers/Members? *
Name(s) of ALL Owners/Partners/Officers/Memberss *
Driver 1 Legal Name as appears on License *
Does Driver 1 have a Georgia Drivers License *

Date of Birth for Driver #1 *
Driver 1 License Number *
Driver 1 Any violations, accidents or claims in past 36 months *

Driver 2 Legal Name as appears on License or type "NA" *
Does Driver 2 have a Georgia Drivers License or select "NA" *


Driver 2 Date of Birth or type "NA" *
Driver 2 License Number or type "NA" *
Driver 2 Any violations, accidents or claims in 3 years or select "NA" *


Driver 3 Name as appears on License or type "NA" *
Does Driver 3 have a Georgia Drivers License or select "NA" *


Driver 3 Date of Birth or type "NA" *
Driver 3 License Number or type "NA" *
Driver 3 Any violations, accidents or claims in 3 years or select "NA" *


Driver 4 Name as appears on License or type "NA" *
Does Driver 4 have a Georgia Drivers License or select "NA" *


Driver 4 Date of Birth or type "NA" *
Driver 4 License Number or type "NA" *
Driver 4 Any violations, accidents or claims in 3 years or select "NA" *


Name(s) of any Clerical Employee or type "NONE" *
Name of the Dealership's employed Mechanic or type "NONE" *
Will or does the Dealership hire Contract Drivers from the auctions to drive the Dealership's vehicles back to its lot? *

Does the Dealership employee Vehicle Detailer(s)? *

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

GENERAL DEAERLER QUESTIONS
Anyone allowed to drive a Dealership vehicle home or after hours? *

If someone drives a Dealership vehicle home or drivers after hours, list name or names. If no one drives a Dealership vehicle home or after hours type "NONE" *
Name of the Dealership's current insurance carrier or type "New Start Up" or None *
Has there been a lapse in coverage during the past 3 years? *


Has the Dealership had any claims or losses during the past 3 years? *


Does the Dealership offer "Buy Here Pay Here"? *

Will you use your own money (Dealership money) to finance for customers? *

Does your Dealership do any type of repossession? *

Does the Dealership Lease, Rent or Loan Vehicles? *

Does the Dealership use its vehicles for ride share (Uber Eats, etc)? *

Will you sell, rebuild, or repair auto with a salvage title? *

Does your Dealership have a Tow Truck? *

For the Owner - is there a personal insurance policy? *

If the owner(s) has personal car insurance, list the insurance company's name beside the owner(s) name or type "NONE". Example: John Doe with Progressive and Bill Doe with Safeco or John Doe with Progressive and Bill Doe "None" or Neither "NONE" *
Do you need a Bond with your Liability insurance? *


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, please type "NA" *
PLEASE LET US KNOW
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.
I am an Owner/Partner/Officer/Member of the Dealership and by typing my name warrants my signature. *
ADDITIONAL INFORMATION NEEDED
After you have submitted your quote request, we may need to obtain your Claim History or a copy of your Current Policy if applicable.
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.

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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

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