Tow Truck / Garage Insurance Quick Quote Application
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Company Name
Contact Name
First Name
Last Name
Phone Number
E-mail
example@example.com
FEIN # or SS #
Physical Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
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Libya
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Mali
Malta
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Mauritius
Mayotte
Mexico
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Moldova
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Mongolia
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Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
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Netherlands
Netherlands Antilles
New Caledonia
New Zealand
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Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
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Pitcairn Islands
Poland
Portugal
Puerto Rico
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Republic of the Congo
Romania
Russia
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Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
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Senegal
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South Sudan
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Sri Lanka
Sudan
Suriname
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eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Is the mailing address the same as the physical address?
Yes
No
Mailing Address (if different than physical address)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
How many years have you been in business? If a new venture, state New.
How many years experience do you have in the towing or garage business?
Auto Liability Limit (Pick One)
$1 Million
$750,000
$500,000
$300,000
Other
Physical Damage Deductible (Comp/Collision)
$1,000
$2,500
$5,000
Other
Garage Liability Limit (Pick One)
$1 Million
$750,000
$500,000
$300,000
Other
Garage Keepers Limit (Pick One)
$50,000
$100,000
$250,000
Other
Garage Keepers (physical damage for customer's vehicles in your care, custody, and control). Which one do you carry?
Legal Liability Basis (GKLL)
Direct Primary Basis (GKDP)
Not sure
On-Hook Limit (Pick One)
$25,000
$50,000
$100,000
Other
Garage Keepers Values - Per Location
Dealers Open Lot (Comp/Collision - Owned Vehicles) - Per Location
Dealers Open Lot - Avg/Max Values
Has your insurance ever cancelled or non-renewed?
Yes
No
If Yes, why?
What is your estimated Annual Gross Receipts for all your operations?
Estimated $
What is your AVERAGE RADIUS of operation?
Please Select
0 - 50 Miles
50 - 100 Miles
100+ Miles
Which operations are you engaged in?
Towing & Storage
Repair Shop/Body Shop
Used Car Sales
Towing Related Questions
What percentage (%) of your operation is from the following?
Do you use air bags?
Yes
No
Do you always use safety chains?
Yes
No
Are you equipped with wheel lifts?
Yes
No
Do you lift or haul other than vehicles?
Yes
No
SCHEDULED VEHICLES (Truck & Trailer)
Repair Shop / Body Shop Questions
What percentage (%) of your operation is from the following?
What percentage (%) of your operation is from the following?
If you operate a Body Shop, do you have a UL approved paint booth?
YES
NO
Do you sell/service tires?
YES
NO
Used Car Sales / Salvage Related Questions
What percentage (%) of your operation is from the following?
How many dealer plates do you use?
Where do you purchase vehicles?
Who drives or transports vehicles to your lot?
How many trips per year?
Average miles per one-way trip?
Are you engaged in any of these? (Select all that apply)
Internet Sales
Lease or rent to own autos
Repossess Autos
Consignment of Autos
Salvage Operations
Do employees accompany customers on test drives?
Yes
No
SCHEDULED DRIVERS / EMPLOYEES
Describe alarm or security.
Any Dogs/Animals allowed/kept at any location?
Yes
No
Where are the keys kept?
Who is your current Insurance Company?
Have you had any losses or claims in the last 5 years?
YES
NO
List all losses/claims in the last 5 years.
What is your Estimated Total Annual Premium ($)?
How did you hear about us?
Please Select
Chris Arceri
Ruth Bush
Joel Overton
Postcard
Phone Call
Referred by friend/client
Google Search
Text Message
Email
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