Order Insurance Windfall !
ORDER FORM for INSURANCE


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APPLICATION FORM



If I cannot collect on Insurance as you say, I want my money refunded.

Enclosed is $33 for Transferring cash from Insurance to my Account. (ref. cleanfile.com).
Enclosed is $2 extra for priority handling.

NAME:
ADDRESS:
CITY: STATE:
ZIP: AREACODE/PHONE:
EMAIL:(print)
How did you find us (search engine, kywrds., etc.)?:

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