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     Robert Barké
    Independent Broker

Life

Health

Financial

Disability


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Date of Birth:
Do you smoke?   Yes    No
Any medications?   Yes    No

I would like information on the following:
Life Insurance
Life Insurance for Spouse
Juvenille Life Insurance
Business needs Life Insurance
Life Insurance to pay Mortgage
Retirement Income Planning
Business Protection Planning
Estate/Trusts Organization
Disability Income Insurance
Vision and Dental Insurance
IRA's and Roth IRA's
Long Term Care Insurance
Simple 401k and 401k
Group Insurance
Individual Health Insurance
Supplemental Plans
Other Insurance needs
Review my present policies

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