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Agent of Record Form

Submit your policy information below to transfer your current policies to Highland Park Insurance.

Agent of Record FormGravity Certs2024-09-14T14:39:27-05:00

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Click Import My Insurance above to find your current insurance company and securely populate this form with your policy information.
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2nd Policy
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    I wish to name Eric Graves as our exclusive representative for the policy numbers entered above, currently in force or submitted by application. This authorization replaces any other authorization that may have been previously completed for any other insurance representative for the stated lines of business.*
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    Dallas, Texas 75206
    Phone: 214-699-7484
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    Dallas, TX 75205

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