You or someone you know may have thought you were prepared for the unthinkable. You’ve gotten insurance, paid your dues, and yet, something from out of the blue has occurred.  Maybe it’s an illness, injury, or a catastrophic life event.


    Code 4 is here to back you up!


    Please fill out the form below so that we can consider your situation and get you the assistance you need.  When filling out the details portion, include a brief outline of the circumstances. Also include your phone number and a good time to call.

    Name:  
    Law Enforcement Agency:  
    How did your hear about C4F?:  
    Email:  
    Phone Number:  
    This request for backup is for:  
    Details:  

    OFFICIAL BACKUP REQUEST FORM