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PERSONAL INFORMATION
First Name
Middle Name
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Coverage
Comprehensive Deductible
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What precentage of your vehicles total use time is driven by you?
How many miles will you drive your car annually? (approximately)
Do you currently have insurance?
What Insurance Company if insured?
Comments
The Alliance Group
245 Meadow Path Drive SW Suite 110
Marietta, GA 30064
Tel: 770-438-1188
Fax: 770-438-9999
rjones@taginsurance.com

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