Enroll Here

We have made enrolling simple.  Enrollment in any program is optional.  Coverages may not be available in all states. Please contact our Customer Service representative for details and availability. Find your state below, then click on the form you wish to download.   

Current Pre K-12 Student Accident and/or Catastrophic Accident accounts with Special Markets Insurance Consultants, Inc. must use the enrollment forms and rates sent with their renewal letters.

Any account with Total Premium Due of $10,000.00 or more must have underwriter review/approval prior to acceptance and binding.