Life Insurance Quotes for New York Business

Do you have questions about

Group Employee Term

Life Insurance Quotes

Group Term Life Insurance Coverage Information:

New York Employee Information:

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

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

Group Term Life Insurance Objective:
Amount of Life Insurance Desired Per Employee:    Other Amount:$

How many employees to be insured:

Did any employee to be insured have health problems during
the past 18 months?
If "Yes", please list information below.

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?

Additional Information or Comments

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

New York Business Information:

**Information received from this Group Term Life 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 life 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 Group Life
Insurance Policy. We are licensed in New York and will not provide quotes for other states.

We are your local Long Island, NY insurance agency, offering affordable
Group Employee Term Life Insurance plan services 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, and everywhere else in Nassau County, Queens County,
Kings County, New York County, Bronx County, Westchester County, and
Suffolk County, NY.