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PROM-3121: Form Background Image Test

driverCount sendDataExpando

NPS Survey Scheduler - Auto

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autos-1-year

firstVehicleYear

autos-1-make

firstVehicleMake

autos-1-model

firstVehicleModel

autos-1-ownership

firstVehicleOwnership

Do you own or lease your $[make] $[model]?

autos-1-primary-use

firstVehiclePrimaryUse

What is the primary use for your $[make] $[model]?

autos-1-mileage-per-day

firstVehicleMileagePerDay

How many miles per day do you drive with your $[make] $[model]?

autos-1-coverage-type

firstVehicleCoverageType

autos-2-add

addSecondVehicle

Add second vehicle? (Save additional 20%)

autos-2-year

secondVehicleYear

autos-2-make

secondVehicleMake

autos-2-model

secondVehicleModel

autos-2-ownership

secondVehicleOwnership

autos-2-primary-use

secondVehiclePrimaryUse

autos-2-mileage-per-day

secondVehicleMileagePerDay

autos-2-coverage-type

secondVehicleCoverageType

autos-3-add

addThirdVehicle

autos-3-year

thirdVehicleYear

autos-3-make

thirdVehicleMake

autos-3-model

thirdVehicleModel

autos-3-ownership

thirdVehicleOwnership

autos-3-primary-use

thirdVehiclePrimaryUse

autos-3-mileage-per-day

thirdVehicleMileagePerDay

autos-3-coverage-type

thirdVehicleCoverageType

has-insurance

hasAutoInsurance

Have you had insurance in the last 30 days?

current-insurer

currentAutoInsurer

years-insured

yearsInsured

How long have you continuously had auto insurance?

driver-count

Multi-driver policies can help you save money.

driverCount

drivers-1-gender

firstDriverGender

drivers-1-marriage

firstDriverMarriage

drivers-1-education

firstDriverEducation

drivers-1-occupation

firstDriverSimpleOccupation

credit-score

creditScore

drivers-1-at-fault

firstDriverAtFault

How many at-fault accidents have you had in the past three (3) years?

drivers-1-tickets

firstDriverTickets

How many tickets have you had in the past three (3) years?

drivers-1-DUI

firstDriverDUI

Have you had a DUI conviction in the past three (3) years or need an SR-22 form?

drivers-1-suspended-revoked

firstDriverSuspendedRevoked

Have you had your license suspended or revoked in the past three (3) years?

drivers-2-relation-to-primary

secondDriverRelationToPrimary

What is your second driver's relation to you?

drivers-2-gender

secondDriverGender

drivers-2-marriage

secondDriverMarriage

drivers-2-education

secondDriverEducation

What is your second driver's education level?

drivers-2-occupation

secondDriverSimpleOccupation

drivers-2-at-fault

secondDriverAtFault

How many at-fault accidents has your second driver had in the past three (3) years?

drivers-2-tickets

secondDriverTickets

How many tickets has your second driver had in the past three (3) years?

drivers-2-DUI

secondDriverDUI

Has your second driver had a DUI conviction in the past three (3) years?

drivers-2-suspended-revoked

secondDriverSuspendedRevoked

Has your second driver had their license suspended or revoked in the past three (3) years?

drivers-2-date-of-birth

secondDateOfBirth

drivers-3-relation-to-primary

thirdDriverRelationToPrimary

What is your third driver's relation to you?

drivers-3-gender

thirdDriverGender

drivers-3-marriage

thirdDriverMarriage

drivers-3-education

thirdDriverEducation

What is your third driver's education level?

drivers-3-occupation

thirdDriverSimpleOccupation

drivers-3-at-fault

thirdDriverAtFault

How many at-fault accidents has your third driver had in the past three (3) years?

drivers-3-tickets

thirdDriverTickets

How many tickets has your third driver had in the past three (3) years?

drivers-3-DUI

thirdDriverDUI

Has your third driver had a DUI conviction in the past three (3) years?

drivers-3-suspended-revoked

thirdDriverSuspendedRevoked

Has your third driver had their license suspended or revoked in the past three (3) years?

drivers-3-date-of-birth

thirdDateOfBirth

own-or-rent

residenceOwnership

home-insurance

bundleWithHomeInsurance

Would you like to check if you qualify for home insurance discounts?

renters-insurance

bundleWithRentersInsurance

Would you like to check if you qualify for renter's insurance discounts?

military-service

militaryService

Have you ever honorably served in the U.S. military?

military-service-spouse

Have you or your spouse ever honorably served in the U.S. military?

auto-intent

autoIntent

date-of-birth

firstDateOfBirth

aarp

driver-name

names

street-address

streetAddress

email

phone

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