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Back to Express Requests

Garage Express Request

*Complete and submit the form below for an Express Premium Indication from OGA’s Small Business Unit

Fax: 405.840.9388 | 800.771.8116
Phone: 405.840.9393 | 800.299.1951

Agency Information
Applicant Information
Prior Carrier & Loss Information

Within a 3 year history

Operations
Type & Percentage of Vehicles Applicant Sells or Services
%
%
%
%
%
%

Please list each: Name | Date of Birth-Age | Furnished Auto (Yes or No) | Job Description/Relationship | Full-Time or Part-Time

E.G.: John Smith | 01/01/1980-31 | Yes | Spouse | Part-Time

*Subject to MVR

Please list each: Name | Date of Birth-Age | Job Description/Relationship | Full-Time or Part-Time

E.G.: John Smith | 01/01/1980-31 | Spouse | Part-Time

Miles
Garage Liability
$ Each Accident
$ Aggregate
Garage Keepers
$ Per Location
$
$
$
Dealers Physical Damage
$ Per Location
$
$
Medical Payments
$
Uninsured Motorist
$