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Car Rental Business Application

Home/Car Rental Business Application
Car Rental Business ApplicationGravity Certs2023-02-28T11:40:33-07:00

"*" indicates required fields

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Primary Business Information

Primary Contact Name*
Business Address*
Vehicle(s) Garaged Address*
Is this your primary business?
MM slash DD slash YYYY

General Business Information

Is this a new operation?*
Is your operation currently for sale?*
Is your operation seasonal in nature?*
Has this business ever operated under any other name?*
Have you filed for bankruptcy within the last 5 years?*
Number of Short-Term Rental Vehicles
Percentage of Private Passenger Vehicles Rented To:
Please enter a number from 0 to 100.
Please enter a number from 0 to 100.
Please enter a number from 0 to 100.
Please enter a number from 0 to 100.
Are any vehicles rented for 1 month or more?*
(Which units, to whom, term of rental or lease.)
Are vehicles ever leased with drivers?*
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.
    Are additional drivers permitted?*
    Do you ask what the vehicle will be used for when driven?*
    Please enter a number from 0 to 100.
    Please enter a number from 0 to 100.
    Do you use an online service giving subscribers credit, driving & criminal history?*
    Are written counter practice procedures furnished to all counter personnel?*
    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?*
      Do you require liability insurance from the rentee?*
      Do you obtain a certificate of liability insurance on any vehicles rented?*
      Do you rent or lease vehicles from others?*
      Are any vehicles rented on a "Rent It Here - Leave it There" basis?*
      Are you required to file evidence of insurance with any state or regulatory authority, or any other authority?*
      Do you have your own repair shop?*
      Are rental contracts pre-numbered?*

      For Commercial Vehicles Only

      If you do NOT rent commercial vehicles, please move to the next section.
      Please enter a number from 0 to 100.
      Please enter a number from 0 to 100.
      Are vehicles rented to trucking firms? (truckers hauling for hire)
      Please enter a number from 0 to 100.
      Will you rent vehicles to be used to carry passengers for hire?
      Are any vehicles rented to hazardous material haulers?

      Previous Three Insurance Carriers

      MM slash DD slash YYYY
      MM slash DD slash YYYY
      MM slash DD slash YYYY

      Loss Experience

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

      Insurance Needs

      Do you need Physical Damage coverage?

      Vehicles To Be Covered

      VIN Year Make Model Actions
             
      There are no Vehicles.

      Maximum number of vehicles reached.

      Are any vehicles Financed / Loss Payees?*
      Do you install GPS systems in vehicles?*
      Do you plan on installing GPS?*
      Do you have kill switched in vehicles?*
      Do you plan on installing kill switches?*
      What is the best time to contact you regarding your quote?
      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.
        All the above information is accurate and true to the best of my knowledge.*
        This field is for validation purposes and should be left unchanged.

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        Lincoln Insurance

        1333 E 9400 S Suite 105
        Sandy, Utah 84091
        Phone: 801-601-3101
        Fax: 801-601-3120

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