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NAME:
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ADDRESS
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CITY, STATE, ZIP CODE
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PHONE NUMBER:
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EMAIL ADDRESS:
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NUMBER OF DRIVERS IN HOUSEHOLD:
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NUMBER OF LICENSED VEHICLES:
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CURRENT INSURANCE COMPANY:
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DO YOU OWN OR RENT THE RESIDENCE?
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COMMENTS:
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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.
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