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DATE \@ "dddd, MMMM dd, yyyy"Friday, June 15, 2007
To: BUTWIN INSURANCE GROUP
Expanded Market Program
Fax: 516-466-4213
From
NAME: _____________________________
PHONE: _____________________________
E-MAIL: _____________________________
Number of pages (incl. cover): _____
Attached as checked:
Brokering Agreement, (completed and signed)E&O certificateP&C License (& Corporate License, if applicable)
INCLUDEPICTURE "cid:image001.gif@01C66D32.334E4E00" \* MERGEFORMATINET
FAX
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