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Sunday, May 20, 2012
Forms

Submiting forms:

1. Type the required information in the gray boxes on the form, print the completed form, and fax to 888-329-8842.

 

2. Print the form first, handwrite in the necessary information, and fax it to 888-329-8842.

 
Personal Insurance Forms

Personal Insurance Forms:

Request Change of Broker Record (Please type in your information in the gray boxes provided, print and mail to your current insurance carrier)
 
Commercial Insurance Forms
MVR Release (Note: If you are a business owner please have your employee(s) type in their information in the gray boxes provided. Once completed the form can be printed for the employee(s) signature and date of completion. The form can be returned via fax 559-440-9752 or mail to PO Box 27020, Fresno, CA 93729-7020)
Request Change of Broker of Record (Note: Please type in your information in the gray boxes provided, print and mail to your current insurance carrier)
Request of Loss Runs (Note:Please type in your information in the gray boxes provided, print and mail to your current insurance carrier)
 
Scripter
 
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Securities offered through Sammons Securities Company, LLC.  Member FINRA/SIPC
Registered Branch - 410 W Center Ave, Ste 102, Visalia CA 93291 - 800-549-4242
Lic. 0655225

 
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