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  independent insurance agents - All insurance agents receive 10% commission  
 
* = Required to obtain a quote/contract.

Click here for application in PDF Format.

Contact Information:    
* Insurance Representative: spacer
* Agency Name:  
Address:  
City:  
State:  
  Zip:  
* Phone:  
Fax:  
* E-Mail Address:  
Would you like the contract sent directly to you or your client:
Check One 		  Agent Client
* Contact Person (Name):  
* Name of Organization:  
Address:  
City:  
State:  
Zip:  
Phone:  
Fax:  
Tournament Chairman:  
Phone:  
Fax:  
Tournament Information:    
Tournament Date:  
Number of days in tournament:   If tournament is 1 day type "1"
Tournament Title:  
Golf Course Information:    
Golf Course:  
City:  
State:  
Zip:  
Phone:  
Is this a 9 hole course?   Yes
No
Is there more that 1 course at this location?   Yes
No
Prize, Hole and Yardage Information    
* Prize Value:  
Check One:   Cash Annuity

Description of the prize (cash, car, boat, etc.):

  

* Number of participants/attempt:

  

amateurs

Will there be any professionals playing?   Yes
No

Please Select Below:
If professionals are playing please check what type of professionals, and how many will be playing

Club Professionals

   
Number of Club Professionals:  
     
Touring Professionals    
Number of Touring Professionals  
Please Select Below:
Minimum yardage requirement 135 for men and women, women must shoot within 15 yards of the men on the target hole.

Target Hole #:

  

Yardage:

   For Men
For Women

Course:

  
Loss History on Target Hole:   (Number of hole-in-one's scored on the target hole)

Three free additional hole-in-one prizes for remaining par 3's

Please Select Below:
 Minimum yardage requirement 135 for men, 120 for women.
Minimum yardage requirement 135 for men, 120 for women.
 Hole#: Yardage: Men/ Women, Course:
Hole#: Yardage: Men/ Women, Course:
Hole#: Yardage: Men/ Women, Course:
What are the additional prizes?

I would like the necessary paperwork sent to me via:

If you would like to view the current Terms and Conditions please click here.

* I would like the necessary paperwork sent to me via:

Call CGA with your promotion details:
800-242-7789/Fax: 574-271-1747 or email: info@cgainc.com
Please report an errors with this page to the webmaster

 
 
 
 

2006 CGA, Inc., All Rights Reserved.
12748 Sandy Drive, Suite 110 P.O. Box 518 Granger, IN 46530
(574) 273-5625 (800) 242-7789 Fax: (574) 271-1747
email: info@cgainc.com