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General Business Questionnaire



(Will be audited at expiration)


Limits of Liability Requested:          

(Please note: for General Liability, do not include payroll for clerical employees. For Workers Comp, all employees payroll to be included.)

Describe all Losses, or check



Alliance Ins. Agency of Dallas
11300 N. Central Expy. #202
Dallas, TX 75243

Licensed to offer insurance
in the state of Texas, U.S.A.

(C) 2010 Alliance Insurance
Agency of Dallas
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