Garage Dealers Quote | The Magnolia Agency

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Service Request

For Life Insurance

Call (601) 545-7002

Preferred Effective Date*

Month

Day

Year

Legal Business Name*

Business Address

Years in Business

Years Experience

"if less than 3 years, explain in detail prior experience and any specialized training or certification:

Description of Operations

Business Entity

Individual

Partnership

Corporation

LLC

Insured Contact Name

Insured Contact Email

Insured Contact Phone

Business Address

Please list all owners, employees including those that don't drive covered autos, drivers, and any family members or others who may have access to the autos. Include Name, Date of Birth, Drivers license Number

Please provide your percentage of operations. Must total 100%

REPAIR

Private Passenger Autos, SUVs, pick-ups and Vanes (%)

Antique/Classic Autos Service or Sales(%)

Autonomous Vehicle Service or Sales(%)

Boat Service or Sales(%)

Bus Service and Sales(%)

Commercial Trucks and Trailers Service and Sales(%)

Emergency Vehicle Service or Sales(%)

Farming & Construction Equipment Service or Sales(%)

Mobility Service with Dealer Operations(%)

Motorcycle - Franchised Service or Sales(%)

Motorcycle - Non-franchised Service or Sales(%)

Parking Lots/Structures(%)

Repossesssors (Storage Lot Only)(%)

RV Service - Motorhome and Camping Trailers or Sales(%)

Salvage Yard Service with Dealer Operations(%)

Storage Facilities/Lots(%)

Towing Operators(%)

Valet(%)

Other(%)

SALES

Private passenger autos, suvs, pick-ups and vans service or sales (%)

Antique/Classic Autos Service or Sales(%)

Auction(%)

Auto Broker(%)

Autonomous Vehicle Service or Sales(%)

Boat Service or Sales(%)

Bus Service and Sales(%)

Commercial Trucks and Trailers Service and Sales (%)

Emergency Vehicle Service or Sales(%)

Farming & Construction Equipment Service or Sales(%)

Mobility Service with Dealer Operations (%)

Motorcycle - Franchised Service or Sales (%)

Motorcycle - Non-franchised Service or Sales (%)

RV Service - Motorhome and Camping Trailers or Sales (%)

Salvage Yard Service with Dealer Operations (%)

Wholesale Dealer(%)

Other(%)

Underwriting Questions

Do you have an ownership interest in or operate any other business?

Yes

No

Do you rent any space at this location to another business? *

Yes

No

Are autos loaned to customers?

Yes

No

Are firearms kept on the premises?

Yes

No

Do you have any dogs on the premises?

Yes

No

Do you conduct towing operations?

Yes

No

Do you drive customers' vehicles for the purpose of pick up and/or delivery?

Yes

No

How many Transporter or Repairer Plates (other than Dealer plates) do you have?

Do you lease, rent or loan Dealer, Transporter, or any other type of plates?

Yes

No

Do you lease or rent vehicles?

Yes

No

Do you park customer's vehicles on the street?

Yes

No

Do you ever store or display autos, owned or non-owned, at a different location or lot other than where you conduct Garage Operations?

Yes

No

Do you have an owned vehicle racing or exhibition exposure?

Yes

No

Physical Damage Coverage

Do you need Physical Damage Coverage?

Yes

No

If yes, please answer the following questions

Location Address

Lot Protection

No Protections

Fence and Gate

Post and Cable

Inside Building

Other

Average # of Vehicles Held for Sale on lot

Average value per vehicle

Maximum limit per vehicle

Total Lot Limit

Coverage Requested

Specified Causes of Loss

Comprehensive

Collision Coverage Requested

Yes

No

Types of Vehicles

New

Used

Interest Covered

Owner

Owner and Creditor

Consignment

Loss Payee, if no Loss Payee type "None"

False Pretense Coverage

Yes

No

Address: 206 W Central Ave, Petal, MS 39465 Phone: (601) 545-7002

Hours: Monday - Friday 8 AM–4:30 PM • Saturday & Sunday Closed

©2025 by 5x2 Marketing

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