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Zip
# of incidents*?
None
1
2
3
4
5
Married?
Yes
No
Age
16-20
21-24
25-34
35-44
45-54
55-64
65 and over
Currently Insured?
Yes
No
Homeowner?
Yes
No
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ZIP Code
Age
Select
16-20
21-24
25-34
35-44
45-54
55-64
65 and over
# of incidents*?
Select
1
2
3
4
5
Currently Insured?
Yes
No
Married?
Yes
No
Homeowner?
Yes
No
*Incident: Accident, DUI, SR22 within 3 years (OK to guess)
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