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Corporate Group Health Insurance Quote Request

 To receive a free corporate group health insurance quote from the Perrine Agency, answer the following questions and submit.  An agent will analyze your information and contact you shortly.  You may also print out this page, fill in at your convenience, and fax to us at (952) 888-1134.

 CONTACT INFORMATION
  Company Name
  Your First Name
  Your Last Name
  Street Address
  City
  State
  Zip Code
  Phone (Work) - include area code and extension
  Email Address
 BUSINESS INFORMATION
Do you currently carry a Group Health Insurance Plan?  Yes   No
Type of Business:
Corporation   Sole Proprietor  Partnership
Association    LLC
Describe your business   
  Number of Employees
Requested Plan Preference:  HMO  PPO  Major Medical Not sure
  OPTIONAL COVERAGES
 
Check any additional policies you may be interested in:
 
Group Disability Group Life
Group Dental Group Long Term 
401 K and retirement plans   

What is the best time of day to reach you by phone? 

Enter any comments/ questions/ suggestions below:

Click below to submit information.

 

 
 


"Don was able to find us the best package to meet our needs at the best price and provided friendly, personal service.  Glad we found you!"

Kevin & Jill Unterreiner
Eden Prairie, MN