POWERSPORTS DEALER QUESTIONNAIRE
*
Required.
1
*
Name of Dealership:
2
*
Address:
Address Line 2:
3
*
City:
*
State:
*
Zip:
4
*
Phone:
Fax:
5
*
Name of Contact:
6
*
E-Mail:
7
Website:
8
Tax ID#:
9
Is your dealership franchised?
Yes
No
If so, with whom?
10
Years In Business:
11
Years. Of Management Experience:
12
Current Ownership Dates from:
13
Owners and % of ownership? (Officers):
%
%
%
%
14
Do you sell:
ATV's
Scooters
Boats
15
Do you allow test drives?
Yes
No
If yes, supervised or unsupervised?
16
Do you have a parts and accessories store?
Yes
No
If yes, gross receipts
17
Current Insurance Company?
18
Expiration Dates?
Coverage Limits?
19
Liability:
20
Umbrella:
21
Auto:
22
Inventory per location?
23
Deductible?
24
Reporting/Non-reporting?
25
Is lot fenced?
Yes
No
26
Well-lit?
Yes
No
Property: On each building we need to know the following:
27
Building 1
Building 2
Building 3
Building 4
Amount?
Contents?
Construction:
Sq. Footage:
Year Built:
# Stories:
Deductibles:
If bldg. over 25 yrs old
Year of updates?
Is there a paint booth?
Select
Yes
No
Select
Yes
No
Select
Yes
No
Select
Yes
No
Sprinklered?
Select
Yes
No
Select
Yes
No
Select
Yes
No
Select
Yes
No
Responding Fire Dept:
Burglar alarm:
Select
Local
Central Station
Select
Local
Central Station
Select
Local
Central Station
Select
Local
Central Station
Inland Marine:
28
Tools/Equipment:
29
Machinery:
29
Sign Coverage:
30
Trailers:
31
Garage Liability Limits?
32
GarageKeepers limit?
Employees:
33
Employee 1
Employee 2
Employee 3
Employee 4
Job duties:
payroll:
part-time or full-time:
driving or non-driving:
Drivers:
Date of Birth:
Drivers Licence #:
Social Security #:
34
# of Dealer Plates
35
Furnished Autos and who to?
36
List of Licensed vehicles?
Work Comp info:
37
Current Coverages?
38
Exp. Date:
39
Loss Runs:
40
Experience Mod:
Current Insurance Companies and renewal dates.
41
Current Insurance Companies?
Renewal Date:
42
Dec Pages/Loss runs for 4 years?
43
Comments
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