Disability Insurance Quotes for New York Business

Business Name:
Premises Address:
City:     State:     Zip Code:
Contact Name:
Phone #:    Ext #:    Years in Business:
Email Address: (Required)
Description of Operations or SIC code:

Current Insurance Company:
Policy Expiration Date:          (mm/dd/yyyy)

Do you currently offer short term disability insurance to employees?
Do you currently offer long term disability insurance to employees?
Length of Group Disability Coverage Needed?

Group Disability Coverage For?
Type of Group Disability Coverage Needed?
How many employees to be insured?

Monthly Benefit Amount For Each Person Insured:
Or Enter a Different Monthly Benefit Amount:         $
Benefit Period Desired For Each Person Insured:
Elimination Period Desired For Each Person Insured:
Payment Mode:

Does any employee to be insured have a hazardous job? Yes No
If Yes, how many have hazardous jobs?

Are any employees to be insured active members of the military reserves? Yes No
If Yes, how many are active members of the military reserves?

Explain Any Recent Workers Compensation Claims Below.

Additional Information or Comments

Click on the "Submit Quote Information" button below to send
your New York Group Disability insurance quote request.**

**Information received from this New York Group Employee Disability
Insurance quote request form sent to Insurance Plus will be for our use
only and will not be sold, given to or distributed to any other parties. A
quote will be based on the group disability insurance policy information
provided and does not guarantee acceptance of the risk by us. The precise
coverage afforded is subject to meeting underwriting guidelines, and the
terms, conditions and exclusions of the policy as issued. By submitting
this request you acknowledge that this is neither an offer to insure nor a
guarantee of insurance. Completion of this form does not entitle you to a
New York Group Employee Disability Insurance policy. We are licensed in
New York and will not provide disability insurance quotes for other states.

We are your local Long Island, NY insurance agency, offering
affordable New York Group Disability Insurance quotes to
businesses in the following New York City area cities and counties:
Oyster Bay, Huntington, Glen Cove, Port Washington, Roslyn,
Syosset, Jericho, East Hills, Great Neck, South Huntington, Melville,
Pinelawn, Farmingdale, Bethpage, Levittown, Lindenhurst, Babylon,
Bay Shore, Islip, Northport, Hicksville, Westbury, Mineola, Garden
City, Long Island City, Manhasset, Massapequa, Freeport, Lynbrook,
Rockville Centre, Hempstead, Elmont, Valley Stream, Long Beach,
Oceanside, Amityville, Merrick, Bellmore, Jamaica, Brooklyn, Bronx,
Flatbush, Queens, Astoria, Cove Neck, Bayville, Locust Valley,
Lattingtown, Matinecock, Mill Neck, Sea Cliff, Centre Island,
Brookville, Locust Grove, Muttontown, East Norwich, Old Westbury,
North Massapequa, Seaford, Manorhaven, Huntington Station,
Huntington Bay, Greenlawn, Commack, Plainview, Deer Park,
Farmingdale, West Babylon, Brentwood, Central Islip, East Northport,
Centereach, Coram, Riverhead, Lido Beach, New Suffolk, Port
Jefferson, and everywhere else in Nassau County, Queens County,
Kings County, New York County, Bronx County, Westchester
County, and Suffolk County, NY.