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Questions? E-mail Us At:
debra@goldenruleinsurance.com
   
Garage & Auto Dealer Liability
Insurance Quote Form
Your Personal / Company Data:

Your Name:
Your Company's Name:
Street Address:
City:
*State:
Zip/Postal:
E-Mail (REQUIRED):
Phone:
Fax (optional):
Your Business Type: Corporation
Partnership
Individual
Other

 

Currently Insured?
(If yes, list carrier, and Policy Dates.
If none, type NONE)
 
Current Premium (cost) $
 
List Claims & Amounts Paid
During Last 5 Years
(If none, type NONE)
 
Years In Business:
 
How many dealer tags to you have?
 

 
Underwriting Information:
 
Operations Data:
Describe IN DETAIL,
Your Business Operations:
 
Ownership & Payroll Data:
List Employee's Annual Payroll Here (if none, enter $0): $ Insert # of
Employees here:
 
Number of Employees driving vehicles at work: Number of Employees that do NOT drive at work:
 
Number of Employees driving vehicles over 25 years old: Number of Employees driving vehicle over 72 years old:
NOTE: List any drivers MVR Activity in remarks (tickets, accidents, etc.)
Location & Sales Information:
Insert Annual Gross Revenues from this operation here: $ Square Footage of office or business location:
 
Type of Building (wood frame, concrete, etc.): Number of Stories:
 
Are there other business/residences in this building (describe)?: Describe safety features (alarm, sprinklers, fire protection, etc):
Provide breakdown percentages:
Passenger %  Truck %  Off-the-Road %
 
Coverage Desired: (Check One Please)
Limits of Coverage I am Interested In:
$100,000
$300,000
$500,000
$1 Million
Medical Limit ($1000 or $5000):

Limit of business property needed:
$ property coverage
Limit of open lot (vehicles held for sale) coverage needed:
$ vehicle values
Limit of garagekeepers coverage (value of vehicles in possession):
$ garagekeeper limit
Comp & Coll. Deductibles ($250, 500, 1000 ):

NOTE: Don't worry if you are not exactly sure about coverage type... we will suggest the best coverage for you - just try to tell us what you are looking for! (If we need more info. we will let you know.)
 
Comments/Remarks:

 
Send my quotation via: E-Mail Fax
Regular Mail
Please Call by Phone!

 
Thank you for filling out this form COMPLETELY!

We value your input as PRIVATE information. Every step has been taken to insure your privacy, security, and our intent is to release quote information only to you. We will not give your data to ANY other person or group for sales, marketing, or ANY other purposes. By checking the box below you agree to allow our agency to release this information via the method you have chosen, and to release us from any liability should this information be accidentally viewed by others. Our intention is to maintain your complete privacy.

Yes, I Agree. Please Send Me a
Garage/Auto Dealer Insurance Quote NOW!

*Golden Rule Insurance is licensed to sell insurance in many states. If you are contacting us from a state in which we are not licensed, we will contact you to inform you that we cannot provide you with a quote.

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 Golden Rule Insurance Agency, Inc.   -   PO Box 810, 4065 Hwy 54, Suite One   -   Osage Beach, MO 65065  -  

Phone# 888-635-4668 or 573-348-1731 -  Fax# 573-348-5630 Terms of Use/Privacy Notice -© 2007