I. Dal Farra


General Information Form


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Please mark any of the following items you may be interested in

1. Auto Insurance
2. Homeowners Insurance
3. Life Insurance
4. Annuities
5. Health Insurance
6. Disability Insurance
7. Business Insurance
8. Car Financing
9. Insurance Checkup

If you live outside of the state of Pennsylvania but are planning to relocate here, please answer the following:

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Will you be...

1. Purchasing a house right away?
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