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Automobile Questionnaire Name: Email address: Do we presently insure all of the vehicles in your household? Yes No Do you have any vehicles furnished for your regular use that you do not own, such as a company car? Yes No Do we list all household members on your auto policy? This includes anyone 15 years of age and older. Yes No Do you own any motorcycles, golf carts, all terrain vehicles, mopeds or mini-bikes? Yes No Is your vehicle leased or loaned? Yes No Name of Leinholder? Leinholder address? Account #: Phone #: Would you be interested in speaking with an agent about: Homeowners/Condo/Tenants Long Term Care Umbrella Coverage Estate Planning Insurance for your Business Retirement Planning Individual Health Mutual Funds Asset Inventory Life Insurance If so, when is the best time to call: Phone number:

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