Download an Application for Fifty Plus

USBA Members: If you want to change your existing coverage, please tell us exactly what you want to cancel, replace, or reduce in a statement you sign and date. Then enclose the statement with your application to help us process your request more quickly. All requests for a change in coverage are subject to approval by the insurance company.

Applications are in PDF format readable with Acrobat Reader.

Please tell us how you came to our Web site: Select One Search Engine Website Ad Print Ad Email Friends or Family TV Ad Direct Mail Called USBA Insurance Agent Other Job Fair Alabama State Employee Association Download Application (most states) Download Application (MN residents only) Download Application (NY residents only) Attention Puerto Rico Residents Please contact USBA regarding your application for this product. 1-800-368-7021   Select One Yahoo! Google MSN Other Select One Yahoo! AOL Military.com Hampton Roads/PilotOnline Knight-Ridder TA Online GI Jobs Other Corporate Gray FayettevilleNC.com Military Exits MSN SignOnSanDiego.com Select One GI Jobs Military Times Association Journal Other Select One Destiny Job Site Other Channel Name: Agent Name: Please Name: Select One 1/24/07 Virginia Beach, VA Other