Acord 36 Fillable Pdf

File name: Acord 36 Fillable Pdf

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Link👉Acord 36 Fillable Pdf
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The ACORD name and logo are registered marks of ACORD E-MAIL ADDRESS: PHONE (A/C, No, Ext): FAX (A/C, No): 6/19/ () () Lemark Insurance Agency, . acord date tm © acord corporation code: sub code: agency customer id: producer agent/broker of record change insurance company name company name (if applicable). agent/broker of record change date (mm/dd/yyyy) new agency insurance company namephone (a/c, no, ext): fax (a/c, no): e-mail address: code: subcode: current agency current producer. The ACORD name and logo are registered marks of ACORD ACORD 36 (/01) CURRENT AGENCY CURRENT PRODUCER INSURANCE COMPANY NAME. tm date producer insurance company name code: sub code: agency customer id: policy number(s) effective date expiration date line of business producer. agent/broker of record change date (mm/dd/yyyy) policy number(s) effective date expiration date named insured line of business (as it appears on policy) please be advised that we wish to name. ACORD 36, Agent / Broker Record of Change is used to provide authorization from your customer to the customer's current insurance company. The form notifies the insurer that you have been named as the exclusive representative with respect to policies currently in force. tm date producer insurance company name code: sub code: agency customer id: policy number(s) effective date expiration date line of business producer. agent/broker of record change date (mm/dd/yyyy) new agency insurance company namephone (a/c, no, ext): fax (a/c, no): e-mail address: code: subcode: current agency current producer.