"*" indicates required fields

Primary Business Information

Primary Contact Name*

First Last

Email*

Phone*

Business Name*

DBA

Business Type*

FEIN

Business Address*

Street Address Address Line 2 City State ZIP Code

Vehicle(s) Garaged Address*

Same as Business Address

Street Address Address Line 2 City State ZIP Code

Years in Business*

Is this your primary business?

Yes

If not, please explain

Date you want the policy to start*

MM slash DD slash YYYY

General Business Information

Is this a new operation?*

Yes

Is your operation currently for sale?*

Yes

Is your operation seasonal in nature?*

Yes

Has this business ever operated under any other name?*

Yes

Previous Business Name*

Previous Business Address*

Estimate of Financial Worth*

Gross Receipts Last Year*

Estimate for Coming Year*

Have you filed for bankruptcy within the last 5 years?*

Yes

Please explain bankruptcy*

Number of Short-Term Rental Vehicles

Number of Private Passenger Autos

Number of Pick-Ups

Number of Trucks

Number of SUVs

Number of Semi-Trailers

Number of Trailers

Number of Cargo Vans

Number of Other Vehicles

Others (Specify)

Percentage of Private Passenger Vehicles Rented To:

% Personal

Please enter a number from 0 to 100.

% Military

Please enter a number from 0 to 100.

% Commercial

Please enter a number from 0 to 100.

% Insurance Replacement

Please enter a number from 0 to 100.

Are any vehicles rented for 1 month or more?*

Yes

Please submit details*

(Which units, to whom, term of rental or lease.)

Are vehicles ever leased with drivers?*

Yes

Attach list of driver(s) information

Please include a complete list of driver(s), vehicle(s) they drive, age of driver, license number, and chargeable accidents during the past three years.

Drop files here or

Max. file size: 10 MB.

What is the average length of rental? (in days)*

What are your rules for selecting renters or lessees?

What is the minimum age permitted to rent vehicles?*

Are additional drivers permitted?*

Yes

How are additional drivers qualified?*

Do you ask what the vehicle will be used for when driven?*

Yes

Percent Cash Rental*

Please enter a number from 0 to 100.

Percent Credit Card Rental*

Please enter a number from 0 to 100.

If cash rental, how do you qualify renter?

Do you use an online service giving subscribers credit, driving & criminal history?*

Yes

Who do you use?*

Are written counter practice procedures furnished to all counter personnel?*

Yes

Please attach copy of counter procedures

Drop files here or

Max. file size: 10 MB, Max. files: 1.

Are you named as Additional Insured on renter's policy on any vehicles rented?*

Yes

Explain any Additional Insured requirements or why not required

Do you require liability insurance from the rentee?*

Yes

Explain any liability insurance requirements

Do you obtain a certificate of liability insurance on any vehicles rented?*

Yes

Explain certificate of liability requirements

Do you rent or lease vehicles from others?*

Yes

Please explain renting or leasing from others*

Are any vehicles rented on a "Rent It Here - Leave it There" basis?*

Yes

Are you required to file evidence of insurance with any state or regulatory authority, or any other authority?*

Yes

Please specify the authority(ies)*

Do you have your own repair shop?*

Yes

What kind of repairs are made?*

Are rental contracts pre-numbered?*

Yes

How often are rental vehicles serviced?*

For Commercial Vehicles Only

If you do NOT rent commercial vehicles, please move to the next section.

Percentage of business derived from renting vehicles to individuals hauling their own personal goods or effects

Please enter a number from 0 to 100.

Percentage of business derived from renting vehicles to individuals for business use

Please enter a number from 0 to 100.

Are vehicles rented to trucking firms? (truckers hauling for hire)

Yes

Percentage of business renting to trucking firms

Please enter a number from 0 to 100.

Will you rent vehicles to be used to carry passengers for hire?

Yes

Are any vehicles rented to hazardous material haulers?

Yes

Please explain hazardous material hauling

Previous Three Insurance Carriers

1. Carrier Name

1. Policy Expiration

MM slash DD slash YYYY

1. # Vehicles

1. # Accidents

2. Carrier Name

2. Policy Expiration

MM slash DD slash YYYY

2. # Vehicles

2. # Accidents

3. Carrier Name

3. Policy Expiration

MM slash DD slash YYYY

3. # Vehicles

3. # Accidents

Loss Experience

1. Date of Loss

1. Amount Paid

1. Loss Description

2. Date of Loss

2. Amount Paid

2. Loss Description

3. Date of Loss

3. Amount Paid

3. Loss Description

Have you ever been declined, cancelled, or non-renewed for this kind of insurance?*

Yes

Please specify date and why*

Are you or any applicant aware of any facts or past incidents, circumstances, or situations which could give rise to a claim under the insurance coverage sought in this application?*

Yes

Please provide complete details*

Insurance Needs

Bodily Injury Per Person

Bodily Injury Per Accident

Property Damage Per Accident

Combined Single Limit

Do you need Physical Damage coverage?

Yes

Vehicles To Be Covered

Vehicles

VIN	Year	Make	Model	Actions

There are no Vehicles.

Maximum number of vehicles reached.

Are any vehicles Financed / Loss Payees?*

Yes

Please indicate which vehicle(s) and give name and address of loss payees

Do you install GPS systems in vehicles?*

Yes

Do you plan on installing GPS?*

Yes

Do you have kill switched in vehicles?*

Yes

Do you plan on installing kill switches?*

Yes

What is the best time to contact you regarding your quote?

Morning

Afternoon

Evening

Anytime

Other

What time works best for you?

Would you like a quote from a specific agent?

How were you referred to us?

Additional Comments

Additional Documents

Drop files here or

Max. file size: 10 MB.

Consent*

Like most insurance agencies, we use information from you and other sources, such as your driving and claims histories, insurance score, and other factors to calculate an accurate rate for your insurance. New or updated information may be used to calculate your renewal premium.

I Agree

All the above information is accurate and true to the best of my knowledge.*

Yes

This field is for validation purposes and should be left unchanged.

Car Rental Business Application

Primary Business Information

General Business Information

For Commercial Vehicles Only

Previous Three Insurance Carriers

Loss Experience

Insurance Needs

Vehicles To Be Covered

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Car Rental Business Application

Primary Business Information

General Business Information

For Commercial Vehicles Only

Previous Three Insurance Carriers

Loss Experience

Insurance Needs

Vehicles To Be Covered

Download our app.

Get a Quote

Lincoln Insurance

Navigation

For Clients

Start Your Quote

Select an Insurance Type

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