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Contact Us › Request a Quote  

Please fill out our quote request form below so we can best address your needs.
General questions can be submitted via email at quotes@benefitconsultantsinc.com, or call us at 800-666-5961. We look forward to helping you!

Please select:
Your name
Email
Company
Address 1
Address 2
City, State, Zip
Phone 1
Phone 2
Fax
Best time to call
INDIVIDUAL QUOTE REQUESTS: please complete the following:
Your age or DOB
What products & services are you interested in?
Medical
Dental
Life		 Disability
Long Term Care
Annuities		 Financial Planning
Retirement Plans
Other
Comments & Details
GROUP QUOTE REQUESTS: Please complete the request form that corresponds to your group size/request and/or indicate any of the following below:
What products & services are you interested in?
Medical
Dental
Life		 Disability
Long Term Care
Vision		 Retirement Plans
Other
# of full-time employees
Total # of employees to enroll in benefits
Current Insurance Carrier(s) and Renewal Dates:  
Medical — carrier:  renewal month:
Dental — carrier:  renewal month:
Life — carrier:  renewal month:
Disability — carrier:  renewal month:
LTC — carrier:  renewal month:
Vision — carrier:  renewal month:
Retirement Plan — carrier:  renewal month:
Comments & Details

 

Printable forms also available:

Individual Insurance Quote Request
Small Group - Medical/Dental
Small Group - Life/Disability
Large Group
Retirement Plans
Benefit Consultants, Inc. | 800.666.5961 | info@benefitconsultantsinc.com
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