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Please note: We are in the process of testing the following form for our new website. Any quotes submitted will be reviewed the next business day and one of our agents will reach out to finalize your quote.

Questions? Contact us at 270.465.5502.

 

Please do not submit any protected health information using this form. If any health information is required, we will discuss this confidentially in person or over the phone.

This information is not an offer to sell insurance. Insurance coverage cannot be bound or changed via submission of this online form/application, e-mail, voice mail or facsimile. No binder, insurance policy, change, addition, and/or deletion to insurance coverage goes into effect unless and until confirmed directly with a licensed agent. Note any proposal of insurance we may present to you will be based upon the values developed and exposures to loss disclosed to us on this online form/application and/or in communications with us. All coverages are subject to the terms, conditions and exclusions of the actual policy issued. Not all policies or coverages are available in every state. You also agree to release us from any liability if this information is accidentally viewed by unauthorized persons. We will only use this information for insurance quoting purposes and not distribute to other parties.