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Do you have questions or need a quote?

For general contacts, simply complete the form below. If you'd like a quote, please follow these 2 steps.

You will need our census file to receive a quote.

Send us your completed file using the form below. File types accepted: xls, xlsx, doc, docx, csv, txt, pdf.

Are you willing to offer voluntary disability to your employees through payroll deduction, in order to obtain $10,000 per month of Guarantee Issue Disability for the doctors in your office? This may be a requirement based on the number of doctors in the practice. We will need a census of your office in order to provide a proposal. The census data required is name, date of birth, date of hire, gender, salary, job title and specialty.

First Name*

Last Name*

Title*

Company/Organization*

Address*

City*

State*

Zip Code*

Phone*

Email*

Point of Contact (if different than above)

First Name

Last Name

Phone

Total # of W2 Employees*

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