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Church Insurance Quote
	First & Last Name:
	Street Address:
	City, State & Zip:
	E-Mail Address:
Telephone:		Fax:

	Current Insurance Information
Insurance Company Name:
Policy Exp.:		Amount Insured for:
Any Claims in Last 3 years?


# of floors:		Construction:
Roof type:		Age of roof:
Age of Church:		Full Baths:
1/2 Baths:		Sq. footage:
# of Buildings:		Annual Church Payroll:
# of Playgrounds/Sports Fields:
	Coverages:
Building:		Contents:
Instruments:		Occurances:
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Dimond Bros. Insurance Agency, Inc
111 Sheriff St., P.O. Box 1090
Paris, Illinois 61944
Tel: 217-465-5041
Fax: 217-463-3809
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