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Construction Type:
Kitchen Grade






Cathedral Celling:
Interior Wall 






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Smoker:







Auto insurance with Farmers:




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Central Burglar/Fire Alarm:
Local Electronic Burglar Alarm:









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Phone #
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Head of Household Information Property Address
Comments / Special Instructions
Contact information if different from Head of Household info.
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Phone # :
Loan #
If inmediate assistance is desired please call (909)874-4985
and talk to one of our insurance agents