Transcription of NEW YORK PERSONAL AUTO APPLICATION
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NEW YORK PERSONAL AUTO APPLICATION
ACORD 90 NY (2015/12)ADDITIONAL GARAGING ADDRESS(ES)TAX TERRITORYINDICATE IF MAILING ADDRESS IS GARAGING ADDRESSCARRIERNAIC CODEPOLICY #:PLANPAYMENT PLANTO APPLMAIL POLICYTO AGENTMAIL POLICYAGENCYDIRECTEXPIRATION DATEEFFECTIVE DATEAPPLICANT'S NAME AND MAILING ADDRESS (Include county & ZIP+4)ACCT #:TELEPHONE NUMBERTAX TERRZIP + 4 STATECOUNTYCITYSTREETLOCZIP + 4 STATECITYRENTEDOWNEDCURRENT RESIDENCE ISPREVCURRYRS AT ADDRPREVIOUS STREET ADDRESS (If less than 3 years)RESIDENCENAME:CONTACT(A/C, No, Ext):PHONE(A/C, No):FAXAGENCYSUBCODE:CODE:AGENCY CUSTOMER ID:E-MAILADDRESS: new york PERSONAL auto APPLICATIONDATE (MM/DD/YYYY)The ACORD name and logo are registered marks of ACORD 1981-2015 ACORD CORPORATION.
if you have purchased rental vehicle reimbursement coverage and your vehicle is damaged and is temporarily out of service due to a loss covered under your policy, new york law states that you have
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