[ APPLICATION INSTRUCTIONS FOR AGENTS | QUOTING FORM ]

Application Instructions: FARMERS AGENTS

To process your client's application for  Worker's Compensation insurance in the Association of All Great Retailers we will need the following:

1) A Workers Comp Application (Acord 130)
2) New Member Association Application
3) Farmer's Credit Worksheet (if premium is over $6k)
4) A brief yet accurate report of client's loss history (past 3-years)
5) A check made payable for annual dues to: California Fast Food Safety Association ($100 per location, $250 max)

When the materials are gathered mail complete application to:

C.F.F. c/o © Kevin Osborne Insurance Agency
1419 Burlingame Avenue, Suite 0  |  Burlingame, California 94010
Phone: (650) 347~1717  |  Fax: (650) 347~1707
California License Number: 0777515