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.
