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Underwriting and Discount Questions |
Number of tickets, or
violation in the last 3 years: |
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Number of at fault accidents
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Type of Coverage |
| Liability Bodily Injury: |
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| Liability Property Damage: |
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Comprehensive Deductible
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Uninsured/Under Insured
Motorist: |
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Discounts |
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| Are you currently insured? |
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| How did you hear about us? |
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