Farmer Benefits

Name

Address

Phone (best number to contact you)

Email

Type of Farm Operation

Major Operation (50+ Employees)
Mid-Sized Operation (10 -49 Employees)
Small Sized Operation (1-9 Employees)
Homesteader (small family operation)

Do you currently have coverage?

Yes
No

Which Package would you choose?

Custom
Gold
Silver
Bronze

Optional Benefits

Life Insurance
Accidental Death and Dismemberment
Critical Illness Insurance
Disability Insurance
Health Spending Account
Wellness Spending Account
Tele-medicine

Special Requests