<<Agncy_Name>>
<<Agncy_Address>>
<<Agncy_City>>, <<Agncy_State>>  <<Agncy_Zip>>
Phone: <<Agncy_Phone>> | Fax: <<Agncy_Fax>>



<<Today>>

 
TO: <<Input:Fax Number>>

CLIENT: <<Cli_Name1:PC>>

POLICY NUMBER: <<Pol_PolNum>>

RE: <<Input:Reason sending fax>>

<<User Name>>
Email: <<User_Email>>
Phone: <<Agncy_Phone>>
Fax: <<Agncy_Fax>>