Willis Programs CAR-PAC, TRUCK-PAC and AutoServiceGuard | Insurance Programs for Auto Service Centers, Auto Dealers, Truck Dealers and RV Dealers

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To submit a new Auto, Truck or RV dealer account for quotation, you must be an appointed agent of the Car-Pac or Truck-Pac Program. However, if you are an appointed agent or not and you'd like to know if we will be able to help you on an account, please fill out the "Car-Pac/Truck-Pac QuickSumbit Form" below. One of our representatives will contact you within 2 business days to let you know if we'll be able to help you with this account.

This is intended to serve only as an indicator that the account may qualify for the Car-Pac or Truck-Pac Program. A full submission is required in order to properly evaluate the account, and, if it meets the underwriting guidelines and eligibility criteria, to release a quote proposal.

IMPORTANT: Please note that both the Car-Pac and Truck-Pac Program for New Auto, Truck and RV Dealers has a $50,000 minimum premium. Usually this would be a dealer with more than 25 employees. We do not have an insurance program for exclusively used dealers.

Fields marked with an asterisk (*) are required and must be filled in before submitting the form.

Your Information

*Your Name:
*Your Agency's Name:
*Address:
*City:
*State:
*ZIP:
* Phone:
Fax:
* Email:

How did you hear about us?

* Select one of the following:
TargetPrograms.com
ProgramBusiness.com
IMMS.com
Insurance IQ
Internet search - please specify what site:
Referral - specify from who:
Other - please specify:

Account's Information

Name of Dealership:
*Address:
*City:
*State:
*ZIP:
* Number of Employees:
* Gross Sales:
* Is this a new venture?	Yes No

* What type of dealer is this (no coverage available for exclusively used dealers): Check all that apply:
	Auto		Truck		RV

Additional Information

* Who is the current carrier?

* What is the estimated current premium not including Workers Compensation premium?

* When does it expire?

What is total insured Property Value?

Are they happy with their current carrier?

Why would they leave their current carrier?

*Is this your agency's renewal?

Yes No

If so, how long have you written this account and why are you moving it?

* How much loss information do you have on this account?:
	None		Less than 3 years		3 to 5 years

* Please characterize their losses over last 5 years:
	None	Very light	Frequent but not severe
	Severe but not Frequent	Frequent and severe	Don't know

* How much premium for new Auto or Truck dealerships do you currently write in your agency?

* How much premium for Auto or Truck service centers and gas stations do you currently write in your agency?

Other information you would like to provide: