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Your Vehicles


	If you have more than four vehicles, please call our office for a quote.

	Vehicle 1

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Vehicle Use *Racing/Commercial Unacceptable

Custom or modified?	Yes No

Turbocharged or supercharged?	Yes No

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Optional Coverages:	Towing and Labor Roadside Assistance

Vehicle 2


Year:

Make and model:

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Vehicle type:

Vehicle Use *Racing/Commercial Unacceptable

Custom or modified?	Yes No

Turbocharged or supercharged?	Yes No

Total CC's:

Comprehensive:

Collision:

Optional Coverages:	Towing and Labor Roadside Assistance

Vehicle 3


Year:

Make and model:

VIN (if known):

Vehicle type:

Vehicle Use *Racing/Commercial Unacceptable

Custom or modified?	Yes No

Turbocharged or supercharged?	Yes No

Total CC's:

Comprehensive:

Collision:

Optional Coverages:	Towing and Labor Roadside Assistance

Vehicle 4


Year:

Make and model:

VIN (if known):

Vehicle type:

Vehicle Use *Racing/Commercial Unacceptable

Custom or modified?	Yes No

Turbocharged or supercharged?	Yes No

Total CC's:

Comprehensive:

Collision:

Optional Coverages:	Towing and Labor Roadside Assistance

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	If there are more than four drivers, please call our office for a quote.

	Driver 1

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	Driver 3

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Sex:	Male Female

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	Driver 4

Name:

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1135 Round Lake Rd.
White Lake, Michigan 48386