DAC Insurance 4H Fair Contest Additional Entries "*" indicates required fields Name* First Last Email* Mobile*Drawings Announced by TextCheck all that Apply (1 Additional Entry)DAC Insurance would like to provide a free insurance review sometime in the next year. If you continue you are allowing us to connect with you for that purpose. Own and Insure my Home Currently Insure an Auto I own and Insure a business I Volunteer/Serve with a Non Profit or Church Select AllNumber of Autos Insured1234+My Position Where I Volunteer/Serve (1 Additional Entry)Tell us how your connected to the Cause you serve at Administration or Staff Board or Committee Member or Volunteer I Feel My Insurance Cost Is... (1 Additional Entry) I Think I'm Paying Too Much! My Insurance Price is About Right I Don't Know if my Rate is Fair Open to a 2nd Opinion Quote When I Renew Yes No I Think my Coverage Is.... (1 Additional Entry) I Purchase the Best Coverage I Have Average, but OK Coverage I Don't Know if my Coverage is Right I pay my Auto Insurance: (1 Additional Entry) Monthly 6-Months (Semi Annual) Yearly Other (i.e. 90 or 60 days) My Insurance Premium is Next Due (1 Additional Entry)Select the Next Month your Insurance is dueAugSepOctNovDecJanFebMarchAprilMayJuneJulyAddress (2 Entries) Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code This field is hidden when viewing the formCurrent Contest Contest Rules
