IDAR Rate Quote Request | Northland Auto Solutions

SECTION 1 - CURRENT BUSINESS INFORMATION

Business Name*

DBA Name (optional)

Owners Name*

Owners Phone*

Owners Email*

% of Ownership*

Years with Business*

Are you actively involved with daily operations?*

Yes
No

Main Contact Name*

Main Contact Phone*

Main Contact Email*

Years with Business*

Are you actively involved with daily operations?*

Yes
No

Business Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Business Phone*

Business Fax

Federal ID #*

Year Current Business was Established*

Type of Business*

Indicate percentage of each in relation to the CURRENT total operation

% New Car Sales*

% Repossessions*

% Gasoline Sales*

% Used Car Sales*

% Auto Leasing / RTO*

% Propane Sales*

% Consignment Sales*

% Truck Rental*

% Mini-Mart Operation*

% Auto Body Work*

% Towing Service*

% Auto Rental*

% Auto Repair Work*

% Auto Parts Sales*

% Tire Sales*

% Vehicle Storage Lot*

% Park & Fly Operations*

% Trailer Sales*

Additional Locations*

Yes
No

If yes, list addresses and # of cars

Do you plan to open any additional locations within 12 months?*

Yes
No

Are there any other business names, entities, corporations, or interests not listed above?*

Yes
No

If yes, list them and explain

Do you have any business insurance currently in force?*

Yes
No

If yes, list Type of Insurance Policy, Insurance Company, Liability Limit, and Expiration Date

Do you have any other fleet operations insurance elsewhere?*

Yes
No

If yes, please explain

Have you ever owned/operated a rental agency?*

Yes
No

If yes, please list companies and explain

SECTION 2 - COUNTER PROCEDURES

DOWNLOAD COUNTER PROCEDURES HERE

DOWNLOAD

Will you use Northland's IDAR rental agreement?*

Yes
No

Will additional renters always be listed on the rental agreement?*

Yes
No

Will additional renters be qualified the same as the primary renter?*

Yes
No

I have received Northland's counter procedure guidelines and I agree to adhere to the guidelines without exception.*

Yes
No

If no, please explain why - Be specific

SECTION 3A - TYPES OF RENTALS

% Business*

% Pleasure*

% Loaner*

% Insurance Replacement*

% Military*

SECTION 3B - PAYMENT METHOD

% Cash*

% Credit Card*

% Insurance Replacement

SECTION 4 - FLEET PROFILE

# of Vehicles to start (at least 1 vehicle is required)*

% Private Passenger*

% Exotic/High Value*

% Pick-Ups*

% Mini-Vans*

% 15 Passenger Vans*

% Cargo Vans*

% Trucks*

% Service Vehicles*

% Shuttles*

% Other*

SECTION 5 - AUTOS NOT AVAILABLE TO RENT

Will any rental autos be used personally by officers, employees, friends, or family?*

Yes
No

Will employees use their own autos for business use?*

Yes
No

Is there any transportation of customers to or from rental locations?*

Yes
No

Is there any towing or transportation of rental units?*

Yes
No

Is there any lending of vehicles to other rental operations?*

Yes
No

Is there any one-way rentals?*

Yes
No

Is there any Peer-to-Peer/Car Sharing/Limousine/Uber or Lyft rentals? (Not Allowed With IDAR)

Yes
No

Is there any Rent-To-Own Rentals or Long Term Leasing (More than 12 months)

Yes
No

SECTION 6 - VEHICLE MAINTENANCE PROCEDURES

What maintenance procedures are in place on the vehicles?*

What repairs, if any, will the insured do on their vehicles?*

SECTION 7 - STATEMENTS

Have you ever declared bankruptcy?*

Yes
No

If yes, please explain

This application may not be used to bind coverage and no coverage commences. Completion of this application by a prospective insurance buyer is for the purpose of transmitting information only. Any agreement or contract binding insurance coverage must be done on a separate document. Coverage will commence only upon the effective date of a separate contract binding insurance coverage issued by an agent authorized by the company.

By checking this box, I declare to the best of my knowledge that all statements herein are true and no material facts have been suppressed or misstated. I am also aware that my operation may be inspected by the insurance company. In addition, I authorize any prior insurance carrier to release underwriting and claim information to Lancer for the purposes of qualifying my business for the coverages requested. I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above terms of Acceptance.*

ELECTRONIC SIGNATURE - Please type your first and last name.

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No Obligation Quote!

SECTION 1 - CURRENT BUSINESS INFORMATION

SECTION 2 - COUNTER PROCEDURES

DOWNLOAD COUNTER PROCEDURES HERE

SECTION 3A - TYPES OF RENTALS

SECTION 3B - PAYMENT METHOD

SECTION 4 - FLEET PROFILE

SECTION 5 - AUTOS NOT AVAILABLE TO RENT

SECTION 6 - VEHICLE MAINTENANCE PROCEDURES

SECTION 7 - STATEMENTS