Golf Cart Risk Evaluation

What is your first name? **

What is your first name? *

What is your last name? **

What is your last name? *

What is your email address? **

What is your email address? *

What is your phone number? **

What is your phone number? *

Will the golf cart be driven on public roads?

Yes
No

What is the year, make and model of the golf cart?

Year	Make	Model

Please enter the Vehicle Identification Number (VIN) for the golf cart.

What is the purchase price/value of the golf cart?

What type of purchase is this? **

What type of purchase is this? *

Lease
Financed
Cash Purchase

Lien Holder/Leasing Company Drop Down

Please select the lien holder/leasing company for this vehicle. (If the company is not listed or the language is not precise please choose "Other" and enter the details.)

Lien Holder/Leasing Company Other

Please enter the lien holder/leasing company name and address.

What date do you want the coverage to begin?

Will the golf cart be used in any organized race or other competition?

Yes
No

Please provide additional details.

Will the golf cart be rented to others?

Yes
No

Please provide additional details.

Will the golf cart be used to carry persons or cargo for a charge?

Yes
No

Please provide additional details.

Will the golf cart be used for any "business" purpose(s)?

Yes
No

Please provide additional details.

Please select the locations where the golf cart will be driven. (Select all that apply)

On my private property
At a private golf facility

Has any, or will any custom work been done to improve the golf cart?

Yes
No

Please provide a description of the work that was done or will be done to the golf cart?

Please enter the value of the work that was/will be done to the golf cart.

Documents and Comments

Please use this field to upload any relevant insurance documents.

Drop files here or

Max. file size: 128 MB, Max. files: 10.

Please enter any additional remarks in the space below.

Disclaimer: This online questionnaire is a tool used to gather information. It is not an application for insurance. No insurance coverage will be bound or put into effect by submitting this form.

Consumer disclosure: By checking the box below you authorize the Agency who supplied this form to you to contact you via phone, email, and text messaging; to save and share with business partners the information you provided; to obtain consumer reports that may include credit-based reports (where legally allowed), public records, claims history, and driving records so that they can give you accurate insurance quotes. *

I agree *

Golf Cart Risk Evaluation

Documents and Comments

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Golf Cart Risk Evaluation

Documents and Comments

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