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Fill and Sign the Seamstress Contract Agreement Form

Fill and Sign the Seamstress Contract Agreement Form

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State of Alabama Department of Insurance Attachment to Form AL-EAD-1 FORM AL-EAD-2 Drivers license # , Resident State Name of Adjuster: _____________________, ______ D.O.B. _________ ________ __________ (Mo) (Day) Social Security # _______-__________-_________ (YR) Home address: (Street) (City) (State) (Zip) Telephone: (_______) _______________________ (_______)______________________ (_______) ____________________ Home Business Cell E-Mail address: Licensed in Resident State as an Adjuster? Yes ______ No ______ (If no, attach explanation) Drivers license # , Resident State Name of Adjuster: _____________________, ______ D.O.B. _________ ________ __________ (Mo) (Day) Social Security # _______-__________-_________ (YR) Home address: (Street) (City) (State) (Zip) Telephone: (_______) _______________________ (_______)______________________ (_______) ____________________ Home Business Cell E-Mail address: Licensed in Resident State as an Adjuster? Yes ______ No ______ (If no, attach explanation) Drivers license # , Resident State _____________________, ______ Name of Adjuster: D.O.B. _________ ________ __________ (Mo) (Day) Social Security # _______-__________-_________ (YR) Home address: (Street) (City) (State) (Zip) Telephone: (_______) _______________________ (_______)______________________ (_______) ____________________ Home Business E-Mail address: Licensed in Resident State as an Adjuster? Yes ______ No _______ (If no, attach explanation) For Emergency Adjusters only Cell

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