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My Member Information

TSCRA Member Number (if applicable):

I'm Interested In...

Select from the following:

Property & Casualty Insurance (Farm/Ranch/Home/Auto)

Individual Health Insurance (Medical/Dental/Life/Vision)

Group Health Insurance (Medical/Dental/Life/Vision)

If you are seeking BOTH Property & Casualty AND Health Insurance, please COMPLETE THE FORM TWICE (once for P&C and once for Health).

My Contact Information

First Name

Last Name

Address Line 1

Address Line 2

City

State

Zip Code

Email Address

Telephone Number

Property Information

Farm/Ranch Address (Line 1)

Farm/Ranch Address (Line 2)

City

State

Zip Code

How many head of cattle?

Total Acreage?

NOTE: Please send all policy copies and loss runs to: TRussell@higginbotham.net.

Insured Information

Total number of INDIVIDUALS to be insured:

Employee Information

Total number of EMPLOYEES to be insured:

Acknowledgement

By checking this box, I authorize Cattle Raisers Insurance to share my contact information with a third party.