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This form will
allow you to submit by E-Mail, Fax or by Mail.
NOTE: Sending this form by e-mail sends the
information in plain text.
Warning Information:
- If you are using an Apple computer the e-mail submission of your form
should have no warning boxes
- If you are using a PC submission of your form will give you 2 warning
boxes, they are listed below:
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This warning is to let you know that the form will be submitted in
plain text. If you would prefer to Fax or Mail the form,
click the Cancel button. You will be able to Print the form
from the website.
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This warning is to let you know that the form is accessing your e-mail
program to send the information you filled out to the Surplus Line
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