Capuano Insurance, Inc.

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Use this simple form to submit your Rhode Island insurance claim:

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	Name: (Required)
	E-mail: (Required)
	Day telephone:
	Evening telephone:
	Fax:
	Street address:
	City:
	State:
	Zip:
	Type of claim:
	Policy number:
	Time and date of incident:
	Lost or damaged items:
	Your claim:

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