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Rutland Office
105 Center Street,
Rutland, VT 05701
(802) 773-3000
(802) 775-2110
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Woodstock Office
540 West Woodstock Road,
Woodstock, VT 05091
(802) 457-4143
(802) 457-4169
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Auto Insurance
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Automobile 1
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Model
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Do you use this vehicle for any delivery service?
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How many miles to work?
--Select--
Less than 3 miles one way
3 or more, but less than 15
15 or more miles one way
Liability coverage
--Select--
300 combined single limit
500 combined single limit
Medical coverage
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$2,000
$5,000
$10,000
Comprehensive deductible
--Select--
$100
$250
$500
$1,000
None
Collision deductible
--Select--
$100
$250
$500
$1,000
None
Rental coverage
--Select--
$20 per day
$30 per day
None
Towing coverage
--Select--
$25 per occurrence
$25 per occurrence
None
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Automobile 2
Year
Make
Model
Doors
Vin number
Registered in your name?
Yes
No
Are you employed?
Yes
No
What is your occupation?
Do you use this vehicle for any delivery service?
Yes
No
How many miles to work?
--Select--
Less than 3 miles one way
3 or more, but less than 15
15 or more miles one way
Liability coverage
--Select--
300 combined single limit
500 combined single limit
Medical coverage
--Select--
$2,000
$5,000
$10,000
Comprehensive deductible
--Select--
$100
$250
$500
$1,000
None
Collision deductible
--Select--
$100
$250
$500
$1,000
None
Rental coverage
--Select--
$20 per day
$30 per day
None
Towing coverage
--Select--
$25 per occurrence
$25 per occurrence
None
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Next
Automobile 3
Year
Make
Model
Doors
Vin number
Registered in your name?
Yes
No
Are you employed?
Yes
No
What is your occupation?
Do you use this vehicle for any delivery service?
Yes
No
How many miles to work?
--Select--
Less than 3 miles one way
3 or more, but less than 15
15 or more miles one way
Liability coverage
--Select--
300 combined single limit
500 combined single limit
Medical coverage
--Select--
$2,000
$5,000
$10,000
Comprehensive deductible
--Select--
$100
$250
$500
$1,000
None
Collision deductible
--Select--
$100
$250
$500
$1,000
None
Rental coverage
--Select--
$20 per day
$30 per day
None
Towing coverage
--Select--
$25 per occurrence
$25 per occurrence
None
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Driver 1
Driver 1 Name
Birthdate
Gender
Male
Female
Marital status
Single
Married
License Number
Issuing State
Social Security Number
Driving record in the past 5 years
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Driver 2
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Gender
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Female
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License Number
Issuing State
Social Security Number
Driving record in the past 5 years
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Driver 3
Driver 3 Name
Birthdate
Gender
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Female
Marital status
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License Number
Issuing State
Social Security Number
Driving record in the past 5 years
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