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Fill out the following form as completely as possible. Once you have completed the form, click the Submit button to send your information. Your request will be handled promptly.

PERSONAL INFORMATION


First Name
Middle Name
Last Name
Address Line 1
City
State
Zip Code
Daytime Phone() -
E-mail Address
Date of Birth
Current Company
Current Premium
Months with Company
Expiration Date of Policy
Year Built
Roof Type
Construction of Home
Date Purchased
Number of Families living in home
Number of Bedrooms
Liabillity Limits
Deductible Amount
Square Footage
Estimated Value
Dogs
Pool
Claims/Property Losses Past 5 Years
Submission Validation
Comments
Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages.  Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company.  If you have any questions, please feel free to
contact us.

The Alliance Group
245
Meadow Path Drive SW Suite 110
Marietta, GA 30064
Tel: 770-438-1188
Fax: 770-438-9999
rjones@taginsurance.com


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