99ex
07-27-2008, 03:13 AM
Name:
Female or Male:Male
Address (Current):
City:Houston
Zip Code:77058
Date of Birth:
Social Security#:
Drivers License#:
Contact#:8328141677
Vehicle(s) Year/Make/Model:1999 Honda Civic EX
In the past 3 yrs. do you have any moving violations (Ticket) or at-fault accidents? No
Accident #:0
Ticket #:0
What is your current insurance company and how much are you paying? $86
Which coverage do you currently carry (full or liab)?Liability
When was the vehicle purchased?12/13/07
Do you have health insurance?yes
Have you had your drivers’ license for more than three years?yes
Do you have any DWI's or suspended licenses in the past three years? No
Please List any other Drivers you want on your account- Name, Sex, TDL#, SS# and D.O.B: NA
Can you give me a quote on Full Coverage?
Female or Male:Male
Address (Current):
City:Houston
Zip Code:77058
Date of Birth:
Social Security#:
Drivers License#:
Contact#:8328141677
Vehicle(s) Year/Make/Model:1999 Honda Civic EX
In the past 3 yrs. do you have any moving violations (Ticket) or at-fault accidents? No
Accident #:0
Ticket #:0
What is your current insurance company and how much are you paying? $86
Which coverage do you currently carry (full or liab)?Liability
When was the vehicle purchased?12/13/07
Do you have health insurance?yes
Have you had your drivers’ license for more than three years?yes
Do you have any DWI's or suspended licenses in the past three years? No
Please List any other Drivers you want on your account- Name, Sex, TDL#, SS# and D.O.B: NA
Can you give me a quote on Full Coverage?