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POLICY RECOMMENDATIONS(Please check any you are interested in)
Hired & Non-Owned Auto
Section 1: COMPANY INFORMATION
How did you hear about us?
Name of Facility:
Contact First Name:
Date of Birth:
Year business started:
Do you ever process payment cards?
Estimated annual number of payment card transactions:
Desired Effective Date:
Detailed operations descriptions:
Please make sure that you have completed everything to the best of your knowledge before going to the next page.