Disclaimer: I understand that this request for service DOES NOT
constitute ANY CHANGE to my policy, but is rather a submission of
information to the agency for an representative to call in reference
to this submission. (you should receive a fax confirmation for any
change to take effect) There is no obligation on our part to
make any changes ver. an internet submission. This submission
does not constitute a statement or contract for insurance, or bind
coverage.
I have read
and understand and agree with the above disclaimer. (Box must be
checked before submitting request for service..
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