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5427 Shady Ave, Lowville, NY  13367 • (315) 376-7131 • (315) 376-6031

Request an Auto Quote

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Contact Information

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Vehicles

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Driver Information

Driver Training?
Yes
No
Good Student?
Yes
No
Defensive Driving Course?
Yes
No
Driver Training?
Yes
No
Good Student?
Yes
No
Defensive Driving Course?
Yes
No
Driver Training?
Yes
No
Good Student?
Yes
No
Defensive Driving Course?
Yes
No
Driver Training?
Yes
No
Good Student?
Yes
No
Defensive Driving Course?
Yes
No

Driving record, including all accidents, convictions, license suspensions & revocations:

Accidents Within 40 Months
Convictions Within 40 Months
Major Violations Within 10 Years
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Current Coverages

SUM will match the Liability Limit
Additional Death Benefit
Yes
No
OBEL
Yes
No
Spousal Liability
Yes
No
Full Glass?
Yes
No
Customized Equipment?
Yes
No
Towing
$25
$50
$75
$100
Rental
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General Questions

>1 Year?
Yes
No
Cancelled by Current Carrier?
Yes
No
Any Vehicle Used for Business
Yes
No
Any Vehicle Used for Uber/Lyft
Yes
No
Any Other Vehicles in House
Yes
No
Own or Rent?
Own
Rent
MHO
Yes
No
Duration
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