Order Form - King Transit Ltd.

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Name of Client / Insured:*

Address including Postal Code:*

Home Telephone:*

Cell Phone:

Claim Number:*

Date of Loss (Month/Day/Year):

Appointment Dates / Special Instructions:

Name of Adjuster Contact:

Name of Company to Bill:*

Address including Postal Code:*

Telephone:*

Fax:

Email:

Name:

Name Of Company:

Address including Postal Code:

Telephone:

Fax:

Email:

Additional Comments:

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