NEW YORK PROCESSING
/ /
I wish to appoint the Bianchi Agency as my agent of record for my policy upon renewal. Their address is:
2301 Milton Ave, Solvay, NY 13219 - Phone (315)-488-54851 Fax (315)-488-2577
1800 Brewerton Rd Mattydale, NY 13211 - 315-455-5084 Fax 315-410-8991
A Central Mutual
Name Address Phone Email
Policy # is _____________________*
Renewal Date ____________________ *
Please fax a copy of my most recent declarations sheet to them at 315-488-2577.
Sincerely,
________________________________
Bianchi Agency - 2301 Milton Ave - Solvay, NY 13209 - CNYINS@gmail.com
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