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Phone #'s: (home)


Description of Business: # of employees
Do you own or rent the building?: Year built:
Construction of building:    
Give year of all building updates (wiring, plumbing, roof etc.) Building value:
Contents value: Sq. footage:
Annual receipts or sales:    
Annual payroll: Prior carrier & premiums paid:
Limits of liability needed (100/300, 500/500 or 1,000/1,000): Effective date needed:
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Copyright 2010. Welkner Insurance Agency, Inc.
All Rights Reserved.
  1993 S Kanner Hwy,
Stuart, FL 34994

Phone: 772-600-5664
Fax: 772-934-7326

Email: TheWelknerAgency@horacemann.com
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