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Please note that completion of the following request for information does not constitute the purchase of insurance. No coverage may be added, changed or bound as a result of submitting this request for information or quotation of insurance. All coverage must be confirmed by the agency in writing subject to an acceptable signed application meeting the underwriting guidelines of the Insurance Company. By using this form you approve Waterbrook Insurance™ to order consumer reports which will verify your driving record, prior losses, and prior insurance information.