Home








Dealer Profile

Please complete the following Dealer Profile form.   Once you submit the information we will contact you within 24 hours.  If you prefer you may download a printable version click here and fax the completed form to (508) 755-8720

Dealer: 

Dealer Principal: 

Address: 

City:      State:    Zip: 

Phone Number: 

Fax Number: 

E-Mail: 

Web site address: 

Location #1:

Contact:  Title:  Date: 

Loss Control Coordinator:    Title: 

Location #2:

Contact:    Title:    Date: 

Loss Control Coordinator:     Title: 

Unless otherwise indicated, please respond with a Yes or No answer.

Section I.  Personnel

  Loc #1 Loc #2 Loc #3 Loc #4
Safety Program* ( formal or informal?) Formal Formal Formal Formal
Accidents reviewed / investigated by management Yes Yes Yes Yes
Hiring Procedures:  Employment Application Yes Yes Yes Yes
                                   Personal Interview Yes Yes Yes Yes
                                   Physicals Required Yes Yes Yes Yes
                                   Reference Check Yes Yes Yes Yes
                       Pre-employment Drug Test Yes Yes Yes Yes
Employee Breakdown ( Indicate #)        
                                   Management
                                   Service Area
                                   Cashiers
                                   Body Shop
                                   Parts Truck Drivers
                                   Salespersons
                                   All Other
                                   Total

* Please provide detail in narrative section.

Section II.  Demonstrators

  Loc #1 Loc #2 Loc #3 Loc #4
# of Vehicles furnished to Employees
# of Vehicles furnished to Non-employees
Written Demonstrator Agreement in Force? Yes Yes Yes Yes
     If no, will dealer agree to implement? Yes Yes Yes Yes
Current Restrictions:        
                                  Employee use only Yes Yes Yes Yes
                                  Spouse use permitted Yes Yes Yes Yes
                                 Children use permitted Yes Yes Yes Yes
                                 Vacation use permitted Yes Yes Yes Yes
                Driver responsible for deductible Yes Yes Yes Yes

Section III.  Driving Records

  Loc #1 Loc #2 Loc #3 Loc #4
Ordered Prior to Employment Yes Yes Yes Yes
     If no, will dealer agree to implement? Yes Yes Yes Yes
Ordered for non-employee furnished autos Yes Yes Yes Yes
Driving records reviewed annually Yes Yes Yes Yes
Disciplinary action taken for poor experience* Yes Yes Yes Yes
Will dealer cooperate in removing poor drivers from demos? Yes Yes Yes Yes

Section IV.  Security

  Loc #1 Loc #2 Loc #3 Loc #4
Lights left on inside building Yes Yes Yes Yes
Wheel locks used Yes Yes Yes Yes
Batteries disconnected Yes Yes Yes Yes
Front line vehicles disabled Yes Yes Yes Yes
Watchman ( Indicate hours )
Watchclock Yes Yes Yes Yes
Armed Watchman * + Yes Yes Yes Yes
Guard dogs (owned or service?) * + Owned Owned Owned Owned

* Please provide detail in narrative.

+Certificates may be required.

Section V.  Lot Protection

Key:  A = Display    B = Used Storage    C = Customer Vehicles    D = Off Premises

  Loc # 1 Loc # 2 Loc # 3 Loc # 4
  A B C D A B C D A B C D A B C D
Chain link fence
Post and Chain
Guard Rail
Lighted
Watchman
* Other

 

Section VI.  Operations

  Loc #1 Loc #2 Loc #3 Loc #4
Body Shop (Yes / No / Sublet) *
Paint Spraying ( Room or Booth?)
Paint Storage (Cabinets or Room?)
Towing (Customer Service / None / Public?)**
# of service / wrecker vehicles
Truck Tire Repair / Changing * Yes Yes Yes Yes
Sell or Service Buses ** Yes Yes Yes Yes
Sell or Service RV's / Motorcycles / Snowmobiles ** Yes Yes Yes Yes
Junkyard Operation * Yes Yes Yes Yes
Sponsor Special Events / Comp Events ** Yes Yes Yes Yes
Vehicle modifications * Yes Yes Yes Yes
Vehicle provided to service customers Yes Yes Yes Yes
     If yes, is customer rental agreement signed? ++ Yes Yes Yes Yes
     If no, will dealer agree to implement? Yes Yes Yes Yes

Vehicle provided for daily rental other than customer service?

     If yes, Coverage is NOT provided in policy for other than customer service units.

 Yes Yes Yes Yes
Vehicles provided for Driver's Education * + Yes Yes Yes Yes
Customers accompanied on test drive *

     (Always / Usually/ Never)
Pre-planned test drive route Yes Yes Yes Yes
Customers drivers license checked prior to test drive Yes Yes Yes Yes
Copy of license kept in showroom during test drive Yes Yes Yes Yes
     If no, will dealer agree to implement? Yes Yes Yes Yes
Is Dealer located in flood zone? Yes Yes Yes Yes
Dealer plates loaned to customers * Yes Yes Yes Yes

* Please provide detail in narrative.    ** Complete Supplemental questionnaire

+ Certificates may be required.    ++ Please attach a copy.

Describe control of dealer license plates:

Describe the key control utilized for customer vehicles, new and used:

Are Lock boxes (key boxes) used?    Yes No

If yes, are keys removed each night?    Yes No

Monthly insurance premiums last year excluding Workers' Comp:

Total average losses per year for the past three years, excluding Workers' Comp:

Is Dealer using an Independent Insurance Consultant?    Yes  No

If yes, Name of Consultant:

        Consultant's E & O Carrier:

        Limit of Insurance:

Narrative:

 

 

 
Copyright © 2000 Autodealercostcontrol. All rights reserved.

Any information provided by this site is for informational purposes only and no warrants are made as to legality or appropriateness. All information should be reviewed by the dealer's counsel.