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Personal Information
feel free to contact us with questions or comments!
* State
NY
NJ
CT
PA
* Date of Birth
* Marital Status
Single
Married
* Gender
Male
Female
* Coverage
Liability Only
Full Coverage
Comprehensive & Collision
Comprehensive Deductible
250
500
1000
2000
$2500
* Vehicle Usage
Pleasure Only
Work and Pleasue
Work Only
* Bodily Injury Liability
$25,000/$50,000/$10,000
$50,000/$100,000/$50,000
$100,000/$300,000/$50,000
$250,000/$500,000/$250,000
* Do you currently have insurance
Yes
No
Lapse <30 days
Lapse >30 days
* Do you own your home
Yes
No
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