GarageGuys :: Master Mechanic's Tool Protector Program Application

Master Mechanic's Tool Protector Program Application

It will be our privilege to provide you with a free, no-obligation insurance quote. Please provide as much information possible for the most accurate quote. This information will be kept confidential and will be used for quote purposes only.

Application for Facility Coverage

Facility Location and Contact Information
Facility Name:
Address:
City:	State: Zip:
Phone:	Fax:
Email:	Website:

Facility Coverage Details
Number of Mechanics Requiring Coverage:	($10,000 per Mechanic)
Total Value of items greater then $1,500:	(please complete Mechanic's Roster Addendum)

Total value of FACILITY owned permanently installed items as follows:

Dynamometer:		Lifts:		Permanently Installed Compressors:
Current Insurance Carrier Name:				Policy Expiration Date:

If you are affiliated with or are a franchise (Shell, Amoco, Midas, etc.), name of franchise:

Do you own your building?
Do you have a working Central Station Alarm?
Is your shop the sole occupant in your building?
Building Construction:
Have you had property losses in the past 5 years?
Have you ever declared bankruptcy?


Mechanic's Roster Addendum
If you have more then one mechanic that you would like coverage for: 1) When you have submitted the form, click the Back button on your browser 2) Update this section of the form 3) Resubmit the form
Facility Name:
Mechanic's Full Name:
Home Address:
City:	State:	ZIP Code:
Years Experience as a Mechanic:
Professional Certifications:
Date mechanic started employment at this facility:
Is this your only employment?
Social Security Number:

18 Prospect Street, Huntington NY 11743-3318
800-474-5553 or 631-424-2600
Email:: contact@insuregarages.com

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