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Application For Rental Autos and Trucks – Short Term

  1. Home
  2. Application For Rental Autos and Trucks – Short Term
Application For Rental Autos and Trucks – Short TermGravity Certs2023-08-01T15:07:22-06:00

"*" indicates required fields

MM slash DD slash YYYY
Name of Applicant*
Is this your primary business?
Has your business operated under any other name?
Company Address*
Garaging Address of Vehicles*
Is this a new operation?*
Is your operation currently for sale?*
Is your operation seasonal in nature?*
Have you filed for bankruptcy within the last 5 years or contemplating doing so?

Description and Area of Operations

Percentage of private passenger vehicles rented to:
Are any vehicles rented for 1 month or more?
Are vehicles ever leased with drivers?
Are additional drivers permitted?
Do you ask what the vehicle will be used for and where it will be driven?
Do you use an online service giving subscribers credit, driving and criminal history?
Are written counter practice procedures furnished to all counter personnel?
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?
Is applicant required to file evidence of insurance with any state regulatory authority or any other authority?
Do you have your own repair shop?
Are rental contracts pre-numbered?

Questions for Commercial Vehicles

Are vehicles rented to trucking firms (truckers hauling for hire)?
Will you rent vehicles to be used to carry passengers for hire?
Are any vehicles rented to hazardous material haulers?

Previous Insurance Carrier and Loss Experience

List prior insurance carriers information for past three years.
List in order with most recent carrier first.
Policy Term
Company Name
Policy Number
# of Vehicles
# of Accidents
$ Premium
 
Have you ever been declined, cancelled, or non-renewed for this kind of insurance?
Is 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?

Schedule of Vehicles to be Covered

Year Make / Model VIN Est. Annual Mileage Max Radius Operation (miles) Cost When Purchased Actions
           
There are no Vehicles.

Maximum number of vehicles reached.

Do you install GPS Systems in vehicles?
Do you have kill switches in vehicles?

Wrapping Up

What is the best time to contact you regarding your quote?
Drop files here or
Max. file size: 12 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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    Sandy, Utah 84091
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