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Home
Who we are
Products & Services
Request a Quote
Contact Us

Request a quote

Personal coverage

Name*

Email*

Phone

Date of birth*

Smoker status (yes or no)*

Height

Weight

Have you been declined coverage before (yes or no)*

Coverage for Spouse or Child (yes or no)

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Employee benefits

Company name*

Email*

Phone

Do you currently have a benefit plan (yes or no)*

Number of years in business

Number of employees requiring SINGLE coverage*

Number of employees requiring FAMILY coverage*

Do you employ Independent Contractors (yes or no)*

Are your employees covered by WCB (yes or no)*

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Book an appointment

Name*

Email*

Phone

Requested Advisor

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