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» COMPANY INFO company: address: city: state: AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY zip: contact: phone: e-mail: » POLICY current carrier: renewal date: desired carrier: desired effective date: plan type: office copay: hospital copay: drug card copay: out of network deductible: referral needed: yes no co-insurance: 70% 80% » CENSUS DATA census faxed — 201.227.5024 census e-mailed — lfavata@otterstedt.com Employees Name Gender DOB Status Zip Code F M single self/spouse self/children family F M single self/spouse self/children family F M single self/spouse self/children family F M single self/spouse self/children family F M single self/spouse self/children family F M single self/spouse self/children family F M single self/spouse self/children family F M single self/spouse self/children family F M single self/spouse self/children family F M single self/spouse self/children family comments: Where did you hear about us? google yahoo! msn realtor.com sputnik customer referral other
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