Quick Links To Services


Contact info

  • PO Box 5217
    Huntington, CA 92615
    Phone:
    714-593-6414
    Fax:
    714-593-6104
    Email:

* =Required Fields
 
Personal Information
* Full Name    
* Address
City
State
Zip Code
* Phone
Fax
* Email
Best Time to Call
 
Company Information
Company's Name
Position
Current Insurance Carrier (state if none)
If any, Anniversary Date of Current Carrier
Total Number of Employees
Number of Employees to be Insured
Are premiums paid by your company for employee only or family, too?
Current rate coverage for Single
Current rate coverage for Husband & Wife
Current rate coverage for Single Parent & Child
Current rate coverage for Full Family
What do you like or dislike about your current plan?
Additional remarks or requests
Census
Company Name
Street
State
City
Zip Code
 
Employee Data
Employee No. Birth Date Gender Coverage
Employee 1
Employee 2
Employee 3
Employee 4
Employee 5
Employee 6
Employee 7
Employee 8
Employee 9
Employee 10
Employee 11
Employee 12
Employee 13
Employee 14
Employee 15
Employee 16
Employee 17
Employee 18
Employee 19
Employee 20
Employee 21
Employee 22
Employee 23
Employee 24
Employee 25
       
* Enter Security Code:  
   
 
You will receive affordable health insurance quotes from all of the following insurance providers...



When you fill out our form, you will receive health insurance quotes from Aetna, Anthem Blue Cross, Blue Shield of California, Health Net, PacifiCare & United Health Care. We'll help you find individual, family or small business health insurance and the best medical insurance plans for your needs and budget.