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Term
Do you have an Insurance policy today or have you had Insurance coverage within the past 30 days?
6 months
12 months
Yes
No
If you have or had insurance with United Auto in last 30 days.
Yes
No
First Name
Middle Name
Last Name
Zip code
Phone
Email
BI
PD
MP
UM
PIP Deductible
10/20
10
None
500
None
10/20 Stacked
10/20 Non-Stacked
1000
About coverage
BI
PD
MP
UM
PIP Deductible
10/20
100/300
10
50
None
500
None
10/20 Non-Stacked
Drv #
Driver Type
Age
DOB
Gender
Mar
Sat
Years
Licensed
State
Violations
Delete
Driver
1.
M
F
S
M
Florida
Out of State
International
2.
Driver
M
F
S
M
Florida
Out of State
International
3.
Driver
M
F
S
M
Florida
Out of State
International
4.
Driver
M
F
S
M
Florida
Out of State
International
Year
CMP/COL Ded.
Make
Model
Body Type
Vehicle Use
ABS
Air
bag
Towing/
Rental
Delete Vehicle
1.
*none
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
none
250
500
1000
Business
> 15 mi
<= 15 mi
Anti Theft
None
Active
Passive
/Lo Jack
Window Etching
Hood Lock w/ Alarm
Anti Theft/Lo Jack
2.
*none
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
none
250
500
1000
Business
> 15 mi
<= 15 mi
Anti Theft
None
Active
Passive
/Lo Jack
Window Etching
Hood Lock w/ Alarm
Anti Theft/Lo Jack
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© UAIC 2005-2006