Please print out application and credit card form, and fax back to 949-454-2997. If you do not have access to a
fax, please mail back to:
Jack Mowers
26741 Portola Pkwy., Ste 1E #514
Foothill Ranch, CA 92610
If mailing, be sure to include a check made payable to Blue Cross of California. (Do not mail
to Blue Cross.) Please contact me with any questions.
Life insurance can only be added to or purchased with a Blue Cross Health Insurance Policy. Please click on the
link below to see rates and application.
