Utilize our One-Step Online Quote Request Forms to get a pricing indication for your insurance need.



CAR WASH QUOTE
Please fully complete the following data form, and simply click the "Submit" button and we will contact you with an insurance quotation.

Please note we cannot accept binders or policy changes by email, only by phone during normal working hours.



CAR WASH INSURANCE

First Name:
Last Name:
Business Name:
Address:
City:
State:
Zip Code:
Phone Number:
Fax Number:
Email Address:

Who Referred You To Our Site?

UNDERWRITING INFORMATION
 

Number of Owners:

  

Number of Employees:
(or enter none)
Payroll of Owners:
Payroll of Employees:
(or enter none)
Total Annual Gross Receipts:
Total Annual Sub Costs:
Total Number of Coin Operated Bays:
Business License Number:
License Type:
Years of Experience:
How many years have you operated under your current Business Name?
Have you use any other Business Names during the past 5 years? Yes   No
Is This Business Open 24 Hours A Day? Yes   No
Any Deep Frying (Food)? Yes   No
Is There Any Manufacturing, Mixing, Re-Labeling or Repackaging of Products? Yes   No
Is there Filing Of Propane Tanks? Yes   No
Please Describe the Nature of Your Business and ANY Unusual Exposures:

BUILDING AND PROPERTY INFORMATION
 

Total Square Footage of the Building Your Business Is In:

  

Total Square Footage of Your Business Only:
Square Footage of the Customer Area Only:
How Many Stories:
If Two Stories, Ground Floor Square Footage:  
Construction Type:  
Roof Type:  
Roof Updated? Yes   No  
If Yes, Year Roof was Updated:
Protection Distance:
Is the Business in a Brush Area? Yes   No  
Is there Storage more than 1500 Sq Ft? Yes   No  
Are there Smoke Detectors at this Location? Yes   No  
Fire Extinguisher? Yes   No  
Deadbolts on All Doors? Yes   No  
Circuit Breakers? Yes   No  
Electrical Updated? Yes   No  
Heating - Air Conditioning, Thermostatically Controlled?: Yes   No  
Heating - Air Conditioning, Central? Yes   No  
Plumbing Updated? Yes   No  
If Yes, Year Plumbing was Updated:
Interior Automatic Fire Sprinklers: 
Theft Alarm:
Fire Alarm:
Any Restaurants in your Building? Yes   No  
Any Restaurants in your Building "Next to Your Business"? Yes   No  
CLAIMS INFORMATION
 

Losses-Claims in the last 5 years: 

  

 
If yes, Date, Amount Paid and Description of Each Loss-Claim:

COVERAGE INFORMATION
 

Current Insurance Company:

  

How much are You Paying Now?:
Liability Limit Requested:
Building Limit Requested:
Building Deductible Requested:
Business Personal Property (Contents) Limit Requested:
Contents Deductible Requested:
Loss Of Income Limit Requested:
Questions or Comments
or Additional Coverage you may need:

Please press the Submit Button ONCE.
Then wait for online confirmation of your request.
Thank you for your interest.




17821 E 17th St, Suite 100, Tustin, CA 92780 :: LICENSE #0543173