Garage Owners Insurance Quote Request Form

Your Name:*
Business Name:
Street Address:
City, State, ZIP: (Minnesota Only)
Phone Number:*
Email Address:*
Years In Business:
Years of Sales/Repair Experience:
Business Entity:	Individual Partnership C-Corporation S-Corporation LLC Other
Describe Your Operations:
Addresses where you conduct Garage Operations:
Drivers of Company Vehicles: (File Upload or fax to 952-469-1881)
Who drives or tows vehicles to your lot?
Where do you purchase vehicles?
How many times per year do you drive-away more than 300 miles from point of purchase?
How many vehicles do you sell per year?
Of vehicles sold, how many are on consignment?
Indicate percentage of the following sold: (cars, motor homes, travel trailers, trucks or seim-trailers, salvage parts, other)
What is your normal radius of operation?
Describe Security of each of your locations: (Fences, gates, cameras, etc)
Describe your Key Control System:
How many Dealer Plates do you have?
Do you repossess vehicles?	Yes No
Do you sell "salvage titled" vehicles?	Yes No
What percentage of your work is Body/Paint work?
What percentage of your work is from Tune-Up, Mechanical repairs?
Work that you do, check all that apply:	Body/Paint Tune-Up Transmission Brakes Sound Systems Muffler Radiator Wheel Alignment Oil & Lube Window Tint Tires Wash/Detail Upholstery
Do you sell gasoline?	Yes No
Do you sell or distribute LPG?	Yes No
Do you install trailer hitches?	Yes No
Do you have a spray paint booth?	Yes No
Do you recap tires or sell recapped tires?	Yes No
Do you tow for hire?	Yes No
Provide current insurance company name and details including dates of losses?
Number of years insured with this insurance company?
Garage Liability Limits Desired:	$100,000 $300,000 $500,000 $1,000,000
Garagekeepers Coverage Limits & Deductible requested by Location:
Dealers Physical Damage Coverage Limits & Deductible requested by location:
Company Owned Vehicle List: (Fax to 952-469-1881 or upload)
Remarks or Comments:
Permission Requested to Check Records, including MVR*	Yes, required to obtain an insurance quote No, no quote will be provided. Learn more by calling us at 952-469-0414 or click the link below.

You should know: Agents and Insurance Companies must check driving records, history of losses, and run insurance scores to obtain insurance quotes. Insurance scores are unique for each company with some carriers giving large discounts for those with exceptional credit. So what is insurance scoring? Learn More!

We value your input as PRIVATE information. Every step has been taken to insure your privacy, security, and our intent is to release quote results only to you. We will not give your data to any other person or group for sales, marketing, or for any other purpose. By requesting a quote 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.

Bob Meyer of Miller-Hartwig Insurance. Your Trusted Choice Insurance Agent.