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Office 318. 686. 7700 Fax 318. 688. 2457 Date Referred By HOMEOWNER S QUOTE QUESTIONNAIRE Named Insured DOB SSN Mailing Address Phone Email Spouse DOB SSN Employment HOME INFORMATION Location Address if different from mailing Year Built ValueTotal Square Feet Total Stories Construction BRICK FRAME OTHER Number of Bedrooms Number of Baths Carport Fireplaces NONE MASONRY Other Structures YES Describe or Garage NO Any Updates on Heating YES Auxilary Heating NONE SOLAR Rooftype ASPHALT METAL Age...
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Office 318 is a financial disclosure form that certain individuals are required to file.
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