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I certify that
all of the information listed on this form is
correct and true to the best of my knowledge. I
understand that any false information given may
be grounds for immediate refusal of this
application, and denial for coverage with
McCurry Insurance Agency LLC. The staff at
McCurry Insurance Agency LLC. have my permission
to call with any questions related to this
quote. Please select yes to
accept, or no to deny the terms of submitting
this quote.
Yes, I
agree with the terms
No, I do not
agree with the terms
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