Welcome to Mullen Insurance Agency Inc.

Garage Liability/Dealers Open Lot

Quick Quote Sheet

Applicant Information I am:	Agency Name: Producer Name:
required! Email Address: (retail customer or agent)

Customer Information
DBA:		Name:
Location Address:		Years continuous insurance
City:		Years in Business:
County:		Phone:
State:	Only available in Texas.	Fax:
Zip:

Description of your business:

	Year	Make/Model	VIN	Liability/ Physical Damage	GVW	ACV
Scheduled Vehicles
1				Liability PhysDam	lbs
2				Liability PhysDam	lbs
3				Liability PhysDam	lbs
4				Liability PhysDam	lbs
5				Liability PhysDam	lbs

Employees
	Name	DOB	Number/State	Auto furnished for personal use?	Postiion	Driving Record Example: good, 1 speeding, at fault accident
1
2
3
4
5

Coverages
Liability ?	Liability CSL		U/M		PIP
Deductible
Garage Keepers?	Limit Requested	Comp Ded - OR -		SCOL Ded		Collision Ded
Scheduled Autos - Physical Damage	Comp Ded	- OR -	SCOL Ded		Coll Ded
Dealers Open Lot?	Inventory Value
	SCOL Ded		Coll Ded
Fire Theft Supplemental Collision	Protection for vehicles	Average # of vehicles on lot	Average Cost
	Theft coverage applies to protected vehicles only	Maximum # of vehicles on lot	Maximum Cost
False Pretense?	$25,000


Auto Sales
Vehicles sold other than private passenger?	If yes, type and percentage sold

Business Radius	# of Dealer Plates	Dealers P #
Any Wreckers?	Any Trailers?	Any Tow Dollies?
Any reposessions done?		TXDOT filing needed? Number?
Any Salvage, Dismantling operations or sale of salvage title vehicles?
Auto Repair
Type of repairs done

Type of vehicles repaired Do you do any spray painting? Do you have an approved booth?

Average # of cars kept overnight? How are cars stored?

3-Year Prior Carrier and Loss History if no losses, say NONE or NA
	Carrier	Loss amount, date & description
Expiring
1st Prior
2nd Prior

Any other businesses on premises? If yes, describe below.
Additional Information
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