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Driver(s) Information

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10.
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Vehicle Information

1.
Year:
Make:
Model:
Use:
Vehicle Identification Number:
Libility Limits: 25000/50000/25000 50000/100000/50000 100000/300000/100000 250000/500000/250000 500000/1000000/500000
Comprehensive Deductible: 100 250 500 1000
Collision Deductible: 100 250 500 1000
Usage: Pleasure Commute Business Farm
Miles one way to work:

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2.
Year:
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Model:
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Vehicle Identification Number:
Libility Limits: 25000/50000/25000 50000/100000/50000 100000/300000/100000 250000/500000/250000 500000/1000000/500000
Comprehensive Deductible: 100 250 500 1000
Collision Deductible: 100 250 500 1000
Usage: Pleasure Commute Business Farm
Miles one way to work:

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Add Another Vehicle

3.
Year:
Make:
Model:
Use:
Vehicle Identification Number:
Libility Limits: 25000/50000/25000 50000/100000/50000 100000/300000/100000 250000/500000/250000 500000/1000000/500000
Comprehensive Deductible: 100 250 500 1000
Collision Deductible: 100 250 500 1000
Usage: Pleasure Commute Business Farm
Miles one way to work:

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Add Another Vehicle

4.
Year:
Make:
Model:
Use:
Vehicle Identification Number:
Libility Limits: 25000/50000/25000 50000/100000/50000 100000/300000/100000 250000/500000/250000 500000/1000000/500000
Comprehensive Deductible: 100 250 500 1000
Collision Deductible: 100 250 500 1000
Usage: Pleasure Commute Business Farm
Miles one way to work:

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Add Another Vehicle

5.
Year:
Make:
Model:
Use:
Vehicle Identification Number:
Libility Limits: 25000/50000/25000 50000/100000/50000 100000/300000/100000 250000/500000/250000 500000/1000000/500000
Comprehensive Deductible: 100 250 500 1000
Collision Deductible: 100 250 500 1000
Usage: Pleasure Commute Business Farm
Miles one way to work:

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Add Another Vehicle

6.
Year:
Make:
Model:
Use:
Vehicle Identification Number:
Libility Limits: 25000/50000/25000 50000/100000/50000 100000/300000/100000 250000/500000/250000 500000/1000000/500000
Comprehensive Deductible: 100 250 500 1000
Collision Deductible: 100 250 500 1000
Usage: Pleasure Commute Business Farm
Miles one way to work:

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Add Another Vehicle

7.
Year:
Make:
Model:
Use:
Vehicle Identification Number:
Libility Limits: 25000/50000/25000 50000/100000/50000 100000/300000/100000 250000/500000/250000 500000/1000000/500000
Comprehensive Deductible: 100 250 500 1000
Collision Deductible: 100 250 500 1000
Usage: Pleasure Commute Business Farm
Miles one way to work:

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Add Another Vehicle

8.
Year:
Make:
Model:
Use:
Vehicle Identification Number:
Libility Limits: 25000/50000/25000 50000/100000/50000 100000/300000/100000 250000/500000/250000 500000/1000000/500000
Comprehensive Deductible: 100 250 500 1000
Collision Deductible: 100 250 500 1000
Usage: Pleasure Commute Business Farm
Miles one way to work:

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Add Another Vehicle

9.
Year:
Make:
Model:
Use:
Vehicle Identification Number:
Libility Limits: 25000/50000/25000 50000/100000/50000 100000/300000/100000 250000/500000/250000 500000/1000000/500000
Comprehensive Deductible: 100 250 500 1000
Collision Deductible: 100 250 500 1000
Usage: Pleasure Commute Business Farm
Miles one way to work:

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Add Another Vehicle

10.
Year:
Make:
Model:
Use:
Vehicle Identification Number:
Libility Limits: 25000/50000/25000 50000/100000/50000 100000/300000/100000 250000/500000/250000 500000/1000000/500000
Comprehensive Deductible: 100 250 500 1000
Collision Deductible: 100 250 500 1000
Usage: Pleasure Commute Business Farm
Miles one way to work:

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AUTHORIZATION TO REQUEST CONSUMER REPORT The undersigned hereby grants to Davis Insurance, Inc. d/b/a The Davis Agency authority to conduct an investigation of information submitted of my background, including the procurement of my personal credit history, including a credit score, and all other such records deemed proper and necessary in order to price my insurance policy and assess my character, reputation and background in connection with any application for a policy of insurance made by or on behalf of the applicant or upon renewal or rewrite of any such policy. The undersigned hereby understands that an investigative consumer report may be made, which will include information as to character, general reputation, personal characteristics, and mode of living. Upon request, information as to the nature and scope of the report will be provided, if such a report is made. The undersigned acknowledges that, in accordance with the information sharing practices of Davis Insurance, Inc. the information obtained through this authorization may be shared with any Insurance Companies Davis Insurance, Inc. conducts business. However, information obtained by Davis Insurance, Inc. through this authorization will not be shared with any nonaffiliated third parties (i.e. companies or individuals not a part of Davis Insurance, Inc.) except as required as a matter of law.</p> I hereby give my permission for any person, business or institution contacted in such investigation to release any and all information property requested and copies of same, if requested, and do hereby release such person, business or institution from all liability for providing correct information.

I have read and agree with the terms and conditions