Hendrickson Insurance · Sarasota, Florida

Golf cart application.

For a golf cart, low-speed vehicle, or utility vehicle driven around a Gulf Coast community, on course, or on neighborhood streets. This helps us prepare a quote with the right liability and physical damage coverage. Estimates are fine where you are not sure.

A. Owner

First named insured *

Required.

Date of birth

Primary phone *

Required.

Email *

Enter a valid email.

Address *

Required.

City

State

ZIP

Community or neighborhood name

B. Cart

Year

Make

Model

VIN or serial number (if any)

Type

Standard golf cart Low-speed vehicle (LSV, street legal) Utility vehicle

Power

Electric Gas

Number of seats

Top speed (mph)

Value or purchase price

Custom / lift / aftermarket value

C. Usage

Use

On-course only Community roads Public streets Business

Who drives it (household members)

Storage location

D. Coverage Requested

Liability limit

Medical payments

Custom equipment coverage

E. History

List date, type, amount

F. Acknowledgement

I certify that the information above is true and complete to the best of my knowledge. Submitting this form does not bind coverage; coverage is subject to underwriting approval and payment of premium.

Typed signature (full name) *

Required.

Date *

Required.

I agree to the statement above. *

Please confirm to submit.

Back

✓

Thank you — application received

Dennis will review it and follow up shortly with your quote. Questions? Call or text 941-952-7991.

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Please try again, or call/text 941-952-7991 and we’ll take your details directly.