This form should be used to request information only. Requests to begin or end coverage will not be accepted from this form. Please call our office if you do not receive a reply within 48 hours.
J. Broussard Benefits Group 2020 W. Pinhook Road, Suite 301 Lafayette, LA 70508 Tel: 337-237-9934 or 800-378-7716 Fax: 337-237-9937 or 888-841-7239
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