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            Now you are ready to submit the form:

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              Next, tell us about the coverage or coverages you need:


              AutoHomeIndividual HealthUmbrellaRecreationalWatercraftRenter’s InsuranceLife InsuranceWedding Insurance


              NOTE: Before becoming effective, all changes, bind orders, or claim notifications must be confirmed by a PayneWest Insurance representative advising that your request has been processed.

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