Printable Forms from AGU

FringeMark Printable Forms

To use the forms in this Web Site you must have the Adobe Acrobat Reader (version 4.0 or later). If you don't have this software, click on this link to get it. The software is free and easy to install.

Employer Application Form

Complete this form "on-line". Print it, sign it and send it to AGU. Or, print it, complete it by hand (please print in black ink) and then send it.

Employee Enrollment Form

To customize this form, complete the Employer section "on-line", print it and then distribute it to your employees.

FAX completed form(s) to (804)-273-9989

If you prefer, you may mail your form(s) to:

Affinity Group Underwriters
4510 Cox Road, Suite 111
Glen Allen, VA 23060

If you have difficulty or need help with our forms, please call Emma Parrish (toll-free) at 877-673-9797 or send an email to EParrish@agu.net.