AUTO CHECKLIST     Date of Contact: Name: Address: City: State: AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Home Telephone: Work Telephone: Cellphone: Prior Insurance Company: Homeowner: Yes No      Notification of Credit Check: Yes No   Driver #1 Name:     Vehicle Type: Vin#:     Useage: Tickets or Violations:   DL#:    Date of Birth:       Married or Single:     Driver #2 Name:     Vehicle Type: Vin#:     Useage: Tickets or Violations:   DL#:    Date of Birth:       Married or Single:     Any other drivers in the household Any trailers, travel trailers, motor homes or recreational vehicles Liability Limits: Comp Ded        Coll Ded        Towing Rental Reimbursrement