Thank you for filling out this form COMPLETELY! We deem your data submitted as PRIVATE information. Every step has been taken to insure your privacy, security, and to release this information only to you. By checking the box below you agree to allow our agency to release this information via the method you have chosen, and to release them from any liability should this information be accidentally viewed by others. Also, the insurance carriers reserve the right to issue coverage or not, and we cannot guarantee acceptance of a risk until approved by the company. Yes, Please make my payment as described. I understand that no payment is applied, and that any canceled policy is NOT reinstated or in force until written confirmation is received from Thoroughbred Associates. I also understand that there are NO REFUNDS on credit card payments. Any refunds will be sent through the insurance carrier as applicable.

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