Reynolds & Reynolds Insurance Agency
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Your Name
Social Security #
E-Mail
Home Phone
Work Phone
Why?
Not Happy with Present Insurance Company
Please list all claims within the past 5 years.
Include the Date and reason for the claim, and the amount paid.
Past Claims
Property to be Insured:
Address 1
Address 2
City
State
How many:
Coverage to be quoted
Amount of Fire Insurance
All quotes will be provided with the following:
$500 deductible
Other coverage, choices, and riders are available and can be discussed upon request.
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