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QUOTE REQUESTS - Group Insurance

NOTE

For groups with 10 employees/members or less, AIFSI provides the following form to submit quote requests on various products available for your convenience.  However, with more than 10 employees, this can be a cumbersome process for you and we would prefer you to simply FAX, or email us the required information.  

If it's easier for you, please take a moment to complete the appropriate sections of the following Quote Request Form and let us know how you prefer to be contacted.

Name     Title

Company

Address

 City   State   Zip Code +4

E-mail Address

Phone   Best Time To Call FAX

Multiple Locations?   Where?

The Following Information is CRITICAL To Determine Required Participation Levels

Total # Emps   # Full Time   # PT/Temp   # Leased

Tell Us What Coverages You Want To Review and Any Special Requests

CENSUS DATA

                                            Name                  Sex              Age/DOB                           Insuring                                               Location*                         Salary**

 #1        

 #2        

#3        

 #4        

 #5        

 #6        

 #7        

 #8        

 #9        

 #10        

* Location is only needed if you have multiple locations     ** Salary is only needed to quote disability coverages

 

Send mail to information@AIFSI.com with questions or comments about this web site.
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