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Affordable Health
& Dental Insurance |
Business/Group
Health Insurance
Quote
Information
Main Page - with a complete listing of carriers and plans
There is some information needed to prepare quotes for you. Please complete this information and e-mail or fax this so we can quickly respond to you.
Thanks for your request.
This is what will be needed for businesses. If the business has 10 or more employees enrolling, it is best to either give me a call or send an e-mail so we can discuss options and necessary information first.
 | Name of business |
| Name of contact person |
| E-mail address |
| Telephone and fax number |
| Address of business including zip-code |
| County of business |
| Nature of business |
| How long has the business been active? |
| Has the business filed taxes? |
| How many full-time employees are there? |
| Current carrier (none, if there isn't one) |
| Census of employees Age or date of birth Sex Type of coverage (employee only, employee and spouse, employee and how many children, family) County or zip-code of residence |
| Current coverage |
| Census Form for businesses |
I can fax a census sheet if that would make it easier for you. Let me know.
Thanks for your request. I look forward to working with you.
Please e-mail, fax or call with complete information:
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For further information:
e-mail: info@temporary-health-insurance.net
Phone: 407-830-0259