Associations Insurance Agency, Inc., AIAI, an Associa Company
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Automobile Questionnaire
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Property Information
Full Name of Property/Association:
Address of Property/Association, Line 1:
Address of Property/Association, Line 2:
City:
State:
Zip Code:
Name of Management Office:
Name of Contact Person:
Telephone number of Contact Person:
Vehicle Schedule
1
Description of Vehicle (Make / Model):
VIN:
Cost New:
2
Description of Vehicle (Make / Model):
VIN:
Cost New:
3
Description of Vehicle (Make / Model):
VIN:
Cost New:
4
Description of Vehicle (Make / Model):
VIN:
Cost New:
Driver Schedule
1
Driver's Name (First and Last):
Date of Birth:
Drivers License #:
State:
2
Driver's Name (First and Last):
Date of Birth:
Drivers License #:
State:
3
Driver's Name (First and Last):
Date of Birth:
Drivers License #:
State:
4
Driver's Name (First and Last):
Date of Birth:
Drivers License #:
State:
Limits Requested
1
Liability Limit:
Physical Damage:
2
Liability Limit:
Physical Damage:
3
Liability Limit:
Physical Damage:
4
Liability Limit:
Physical Damage: