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Proof of Property Insurance

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REQUEST FOR EVIDENCE OF PROPERTY INSURANCE

This information will only be provided to the insured or loss payee.

Receipt of evidence of property insurance will indicate the processing of your request.  If you fail to receive and evidence of property insurance please call The Murray Insurance Agency at 270-753-4751.

 * indicates required information


Insured's Name *

Property for Which Insurance Provided *

Name of Person Making This Request *

Requester's Phone Number  *

Preferred Method of Delivery (choose one) *
FAX  (if chosen enter fax number here: )
 EMAIL (if chosen enter e-mail address here: )
 MAIL (if chosen enter complete address here: )
 PICK UP AT AGENCY

Questions or Comments:

Please note that this form is for a request only.  By submitting this form it does not bind coverage in any way.  If you do not hear from us in a reasonable amount of time, assume we did not get this request for an insurance quote, and call our office.

I understand that filling out and submitting this form DOES NOT bind coverage in any way, and the only way coverage can be bound will be when I am informed of a binder or policy is issued by the agent representing me.

I have read and agree with the above disclaimer (it is mandatory to check box before request can be sent).


 

 

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