| What is your current insurance company? |
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| What date does your current policy expire/renew? |
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| How long have you been insured with your current insurance company? (no. years) |
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| Will this insurance replace an existing policy? |
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| How much coverage do you want? |
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| Select your Comprehensive Deductible: Pays for damage to your car resulting from accidents other than collision |
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| Select your Collision Deductible: Pays for damage to your car when it collides with another vehicle or object |
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| Have you had any incidents, including traffic tickets, accidents, and insurance claims, within the past 3 years? |
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| Are you interested in a multiple-policy discount (for auto and home insurance)? |
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