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13719 N. Nebraska Ave Suite 103 Tampa, FL 33613
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How Many Vehicles Do You Own?
1
2
3
4
5
6+
None
Household Traffic Tickets in the Past 3 Years
0
1
2
3
4
5
6
7+
How Many Properties Do You Own?
1
2
3
4
5+
None
Household accidents in the past 3 years
0
1
2
3
4
5
6+
Amount of Coverage Desired
$1,000,000
$2,000,000
$3,000,000
$4,000,000
$5,000,000
$10,000,000+
When would you like this policy to start?
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