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"Thank you for all your patient assistance during the state of confusion and helping us bundle everything together for auto and the house in Gregory for Raymond Yokey and Yvonne Ruff. It was a very time consuming task and you helped put us at ease that day. We appreciate also that you used your experience and expertise to help save money on those three policies. As I mentioned, I had found your office searching for a "5 Star" insurance agency to aid in these insurance matters for my Dad. You more than measured up to the "5 Star" rating. I will visit the site from Google again where I located you and make sure to add our complete satisfaction to make sure you keep your "5 Star" rating up to the top. I will highly recommend you to others for their insurance needs. Have a blessed day!"

~ Yvonne Ruff

Auto Loss

Insured
Name: Residence Phone: Business Phone:
Email:
Address: Apt:
City: State: Zip:
Contact Person: Where to Contact: When to Contact:
Residence Phone: Business Phone:
Loss
Location of Accident:
City: State: Zip:
Authority Contacted: Report #: Violations/Citations:
Description of Accident:
Insured Vehicle
Year: Make: Model:
VIN #: Plate #:
Owner's Name: Phone:
Owner's Address: Apt:
City: State: Zip:
Driver's Name: Business Phone: Residence Phone:
Driver's Address: Apt/Ste:
City: State: Zip:
Relation to Insured: Date of Birth: Driver's License #:
Purpose of Use: Used with Permission?
Yes No
Describe Damage: Estimate Amount:
Where can Vehicle be Seen? When?
Property Damaged
Describe Property: (if auto: year, make, model, plate no.)
Other Veh./Prop. Ins.? Company/Agency Name: Policy #:
Yes No
Owner's Name: Business Phone: Residence Phone:
Owner's Address: Apt:
City: State: Zip:
Other Driver's Name: Business Phone: Residence Phone:
Other Driver's Address: Apt:
City: State: Zip:
Describe Damage: Estimate Amount: Where can Damage be Seen?
Injured
Name: Phone: Age:
Address: Apt:
City: State: Zip:
Name: Phone: Age:
Address: Apt:
City: State: Zip:
Witnesses or Passengers
Name: Phone: Age:
Address: Apt:
City: State: Zip:
Name: Phone: Age:
Address: Apt:
City: State: Zip:

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