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© 2009 MOCrop Insurance | Burgher Insurance
MOCrop Insurance & Burgher Insurance are equal opportunity providers. All rights reserved.

2709 E Liberty | Mexico | MO 65265
Toll Free: 1.800.633.6540
Tel: 573.581.4420 | Fax: 573.581.7264

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The U.S. Department of Agriculture (USDA), MOCrop Insurance and Burgher Insurance prohibits discrimination in all its programs and activities on the basis of race, color, national origin, age, disability, and where applicable, sex, marital status, familial status, parental status, religion, sexual orientation, genetic information, political beliefs, reprisal, or because all or part of an individual’s income is derived from any public assistance program. (Not all prohibited bases apply to all programs). Persons with disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA’s TARGET Center at (202) 720-2600 (Voice and TDD).

To file a complaint of discrimination, write to USDA, Director, Office of Civil Rights, 1400 Independence Avenue, S.W. Washington, DC 20250-9410, or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.

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