Fillable MOTORCYCLE SUPPLEMENTAL APPLICATION (Risk Placement Services, Inc.)

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MOTORCYCLE SUPPLEMENTAL APPLICATION (Risk Placement Services, Inc.)

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WHI SUP-26-026 (11-13) Page 1 of 2
MOTORCYCLE SUPPLEMENTAL APPLICATION
(Must accompany WHI APP-138 Application For Garage Policy or WHI APP-135 Garage Renewal Application)
1. Applicant/Insured’s Name:
2. Years experience:
Motorcycle dealership/non-dealership owner:
Specifically with motorcycle: Sales Repair Rebuilding
3. What percentage of your operation involves:
Motorcycles % Go Karts % Watercraft %
ATVs/UTVs % Dirt Bikes % Other % Describe:
Mopeds/Scooters % Trikes %
4. If inventory stored outside, describe how motorcycles are protected:
5. Do you permit off premises test drives? ...................................................................................................... Yes No
If yes, any overnight test drives? ................................................................................................................. Yes No
6. Is anyone furnished a vehicle for personal use or as a demo? ................................................................... Yes No
If yes, advise who is furnished:
7. Is proof of motorcycle license and auto insurance checked prior to all test drives? ................................... Yes No
8. Do you perform any customization or fabrication? ...................................................................................... Yes No
If so, what percentage? .............................................................................................................................. %
Provide details of work performed:
9. Do you perform structural alterations (Fork & Frame)? ............................................................................... Yes No
If so, what percentage? .............................................................................................................................. %
Provide details of work performed:
10. Do you convert bikes to trikes? ................................................................................................................... Yes No
If so, what percentage? .............................................................................................................................. %
Provide details of work performed:
11. Do you manufacture bikes or bike parts? .................................................................................................... Yes No
If so, what percentage? .............................................................................................................................. %
Provide details of work performed:
WHI SUP-26-026 (11-13) Page 2 of 2
12. Do you perform assembly of bikes? ............................................................................................................ Yes No
If so, what percentage? .............................................................................................................................. %
Provide details of work performed:
13. Do you alter the original performance of manufacturer specifications? ...................................................... Yes No
If so, provide details:
14. Do you own or service any motorcycles for racing purposes? .................................................................... Yes No
15. Do you loan or rent motorcycles to others? ................................................................................................. Yes No
FRAUD WARNINGS: Attach completed WHI APP-152, State Fraud Notification Compliance form.
APPLICANT’S NAME:
APPLICANT’S SIGNATURE: DATE:
(Must be signed by an active owner, partner or executive officer.)
PRODUCER’S SIGNATURE: DATE:
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MOTORCYCLE SUPPLEMENTAL APPLICATION (Risk Placement Services, Inc.)

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Completed 30 July 2020

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