Worth Ave. Group - Providing peace of mind to consumers for over 46 years.
College Student Insurance
 

College Plus Print Application

We do accept applications online which can be accessed by clicking here.

 
However, if you prefer to apply via fax or mail you may download the application below.

 
To complete your downloaded application you will need to submit the follwing information:
1. Your desired Coverage Amount and preferred deductible
2. All Student Information including:

• Name

• State/University

• Classification

• Parent/Guardian

• Parent/Guardian Email

• Address and Phone Information

3. Payment Information

Please mail or fax your application with proper payment to:

Worth Ave. Group
P.O. Box 2077
Stillwater, OK 74076
**Make checks payable to Worth Ave. Group**

Fax: 405-372-9584 (credit card payments only)
 

If you have any additional questions regarding your application, please call customer service at 1-800-620-2885 or email us at customerservice@worthavegroup.com.