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Capstone protects your confidentiality and uses industry standards to secure the transmission of this form submittal (refer to Privacy Statement). Quote proposals we provide depend on the completeness and accuracy of the information you give us. If you are unsure about a question, please leave it blank.
Many of our insurance carriers use a credit and claims based proprietary model to generate an insurance score for rating. While you are not required to provide your SSN during the quoting stage, the use of your SSN assures accurate rating and helps us gather additional information from consumer reporting agencies. We use your SSN solely for our business of providing insurance services and never disclose information in an unauthorized way. Capstone uses industry standards of security to safeguard your information. Your SSN is used for insurance rating purposes only and does not affect your credit score.
Please list all members of household 14 years or older.
Please list all accidents or tickets in the last 3-5 years.
Enter all claims or losses (regardless of fault and whether or not insured) or occurrences that may give rise to claims for the last 5 years.
I am interested in obtaining insurance proposals on the following lines of insurance: