To open an account with us, please click here and complete our Broker Application.

Please c omplete the appropriate application and
e-mail or fax it to us at (516) 431-0488.

InstaQuote rate sheets are available for the products indicated below.

Commercial Automobile Application (NY & NJ)
For Business Auto, Truckers or Tow Truck applicants

Supplemental Automobile Schedule (NY & NJ)
For Business Auto, Truckers or Tow Truck applicants if Schedule of Autos has 5 units or more

Trucker's General Liability Application (NY & NJ)
For local and intermediate trucking firms transporting the goods of a third party.
Trucker's General Liability Payroll Worksheet
Required with Trucker's General Liability Applications.
Garage Liability Application
 (NY & NJ Except NY Only For Dealers)*
 For Garage Dealer and Non- Dealer
applicants (service stations, auto repair shops, used car dealers, gas stations with convenience stores, parking garages, etc.)
Convenience Store Liability Supplement Application
(NY & NJ)*
For Non-Dealer applicants with a convenience store exposure (Written in conjunction with Garage Liability policies).
Dealer & Transporter Plate
Application (NY)
 For Dealer and Transporter Plate Liability if applicant requires Transporter Plates only or operates from a non-commercial location

Hired Car Application
(NY & NJ)
For Business Auto and Trucking applicants requiring State or Federal Motor Carrier Filings (Written in conjunction with Lancer Commercial Automobile policies)

Non-Ownership Application
(NY & NJ)
For Business Auto and Trucking applicants requiring Auto Non-Ownership Liability (Written in conjunction with Lancer Commercial Automobile policies)

Garagekeepers Legal Liability & Dealers Open Lot Application (NY & NJ)*
For Garagekeepers Legal Liability applicants (service stations, auto repair shops, parking lots, parking garages, etc.) and for Dealers Open Lot (Physical Damage) applicants (used car dealers)

* Coverage may be offered in the non-admitted market through our Lawrence Excess subsidiary. Download and complete the forms below and submit with application.
For NY Risks
Affidavit By Producing Broker
Notice of Excess Lines Placement/Total Cost Form
For NJ Risks
Certification To Place Risks With Authorized Insurer
Notice of Surplus Lines Offering

Word Document: Download application to your computer in Microsoft Word format by clicking on "Word" link(s). Complete all questions. "TAB" from question to question. To retain a copy for your records, remember to save the completed application to your personal hard-drive. Please print the application and send it to us via fax or mail OR email the application to our Underwriting Department at dcwapplications@lancer-ins.com.

Adobe PDF: Download application to your computer using Adobe Acrobat Reader by clicking on "PDF". This is a "read only" document. Please print the application, fill in all information and send it to us by mail or fax.
Click here to download Adobe Acrobat Reader for free.

D.C. White Agency
370 West Park Ave., P.O. Box 9004, Long Beach, NY 11561
Fax: (516) 431-0488

If you have questions regarding these applications, please contact our Underwriting Department at (516) 431-6200.

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