1099 froms for gallagher bassett form

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Immediatelyafteranaccident,filloutthisformandsendto: GALLAGHERBASSETTINSURANCESERVICE (SeeReverseForCompleteInstructions) B.P.O.ELKS LODGE# THISACCIDENTRESULTEDIN: BODILYINJURY PROPERTYDAMAGEONLY (Please fill in all spaces--This form is to be completed by Lodge management, NOT by the Claimant) LODGENAME ADDRESS STATE ZIPCODE PHONE ACCIDENT REPORT CLIENT: B. P. O. ELKS LODGE# CITY ACCIDENT DATEOFLOSS TIMEOFLOSS...
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1099 froms for gallagher bassett
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