| Insurance Corner Client Service Request |
| We're always looking for ways to make Insurance Corner your insurance agency of choice, request for service 24/7. Early Start - let's you make an insurance request for service at your convenience. |
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| Service Requesting: | Current Policy No. | ||
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| 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. I have read and understand and agree with the above disclaimer. Box must be checked before request any consideration will be given to the form!) |