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NAME:
ADDRESS
CITY, STATE, ZIP CODE
PHONE NUMBER:
EMAIL ADDRESS:
NUMBER OF DRIVERS IN HOUSEHOLD:
NUMBER OF LICENSED VEHICLES:
CURRENT INSURANCE COMPANY:
DO YOU OWN OR RENT THE RESIDENCE?
COMMENTS:
AN AGENT FROM BOOHER & TAYLOR INSURANCE WILL CONTACT YOU
WITHIN 48 HOURS.  PLEASE HAVE THE FOLLOWING INFORMATION READY
FOR A FULL INSURANCE PROPOSAL.

AUTO: NAMES, BIRTH DATES, SOCIAL SECURITY NUMBERS, DRIVERS
LICENSE NUMBERS OF ALL DRIVERS IN HOUSEHOLD.  VEHICLE
IDENTIFICATION NUMBERS (VIN#) ON ALL LICENSED VEHICLES.  
CURRENT LIABILITY COVERAGES AND DEDUCTIBLE AMOUNTS, FOUND
ON DECLARATIONS PAGE OF CURRENT POLICY, AND LIEN HOLDER
INFORMATION.

HOME: YEAR BUILT, SQUARE FOOTAGE, BASIC INFORMATION ABOUT
HOUSE, ANY UPDATES.  PLEASE HAVE A COPY OF THE CURRENT
DECLARATIONS PAGE.