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  • Email
  • Phone
  • Valid Driver's License?
  • Have you had any moving violations?
  • If yes, has it been within the last five years?
  • If yes, please explain
  • Have you ever been convicted of Driving under the Influence, reckless driving or driving while license suspended or revoked or had a Diversion? If yes, when
  • Have you ever been charged or cited for an accident? If yes, please explain
  • Have you ever been convicted of a misdemeanor or felony? If yes, when