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Parry & Son Insurance

Change Coverage — Business/Other

If you wish to add coverage or change coverage on your business fill out and submit this form and we’ll start the process. It’s easy.

Policy Number:

Name of Business:

Name of person making request:

Last, First, Middle:


Phone Numbers:


Best time to be reached:


Best time to be reached:


Mailing Address:

Street or P.O. Box:

City, State, Zip:


Check to add coverage to any that apply.


 Automobile, Add coverage

 General liability Add coverage

 Workers’ comp Add coverage

 Umbrella/excess Add coverage

 Garage Add coverage

 Other Add coverage

No coverage is bound until a written or verbal confirmation is received.


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