Step 1 of 4 25% Garage QuestionnaireContact Name*Company Name/DBA*Phone*FaxE-mail* Company Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Garage Questionnaire (continued)Year Business Started# of locationsAnnual SalesEmployee CountFEIN #Current Insurance CompanyPolicy Expiration DateAny Losses Yes No Please explain any losses - include estimated date, claim cost, etcAverage # of Cars in CareGaragekeepers LimitBuilding ValueYear BuiltSquare FeetContents ValueAlarm Systems Yes No Central/Local Alarm Driver ListFirst and Last Name First Last DOBDriver License #First and Last Name First Last DOBDriver License #First and Last Name First Last DOBDriver License #First and Last Name First Last DOBDriver License #First and Last Name First Last DOBDriver License #First and Last Name First Last DOBDriver License #First and Last Name First Last DOBDriver License # Worker's CompensationTotal Mechanic Payroll (8380)Employee CountTotal Clerical Payroll (8810)Employee CountTotal Body Technician Payroll (8393)Employee CountAdditional Comments or Coverages Needed
