ROTHCO INSURANCE SERVICE, INC.

17360 Colima Road  # 354

Rowland Heights, CA  91748-1628

Fax (626) 964 1447            Lic #  0655631

 

Fax Back Form

 

 

 

   To    Bob Roth, C.P.C.U.

            Rothco Insurance Service, Inc.

            InsuranceStop.Com 

 

   Via Fax to    626-964-1447

 

 

   Company Name     _____________________________________________

 

   Contact Person      _________________________ Title _______________

 

   Address                 _____________________________________________

 

                               _____________________________________________

 

   Telephone               _____________________   Fax  ___________________

 

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   _______       We need info on Group Health Insurance Now!

 

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   _______       Good Timing!    Our current ___________________ insurance renews soon. Please contact us now.

 

   _______       Our current _____________________ insurance renews in _________

                        Please contact us at the appropriate time.

 

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