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DAC Insurance 4H Fair Contest Additional Entries

"*" indicates required fields

Name*

First Last

Email*

Mobile*

Drawings Announced by Text

Check all that Apply (1 Additional Entry)

DAC Insurance would like to provide a free insurance review sometime in the next year. If you continue you are allowing us to connect with you for that purpose.

Own and Insure my Home

Currently Insure an Auto

I own and Insure a business

I Volunteer/Serve with a Non Profit or Church

Number of Autos Insured

My Position Where I Volunteer/Serve (1 Additional Entry)

Tell us how your connected to the Cause you serve at

Administration or Staff

Board or Committee

Member or Volunteer

I Feel My Insurance Cost Is... (1 Additional Entry)

I Think I'm Paying Too Much!

My Insurance Price is About Right

I Don't Know if my Rate is Fair

Open to a 2nd Opinion Quote When I Renew

Yes

No

I Think my Coverage Is.... (1 Additional Entry)

I Purchase the Best Coverage

I Have Average, but OK Coverage

I Don't Know if my Coverage is Right

I pay my Auto Insurance: (1 Additional Entry)

Monthly

6-Months (Semi Annual)

Yearly

Other (i.e. 90 or 60 days)

My Insurance Premium is Next Due (1 Additional Entry)

Select the Next Month your Insurance is due

Address (2 Entries)

Street Address City State ZIP Code

Hidden

Current Contest

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