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Web Dealer Quote Form:
For an accurate quote, please fill in all fields
of this six (6) part form. You can easily navigate this form using the Tab key.
| Thank you for taking the time to fill out this worksheet.
We will use the information you supplied along with customers DMV records and
consumer reports which may include
the insured's credit and financial responsibility information to obtain an insurance
quote for your customer. This information will be
kept confidential
and is used by us and the insurance companies we represent for rating purposes only
and will not be shared with anyone else. By submitting
this form you and the customer you represent are authorizing us to access this information and provide you with
a quote.
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| Kenneth Veale |
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Ryde Insurance Agency
Ryde Insurance Agency
106 W Broadway
Port Jefferson, New York, 11777

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E-mail: Rydemc@aol.com
E-mail:
Ryde Insurance
Phone:631-476-0722
Fax: 631-476-1378
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