Kentucky Employee Benefits Insurance Quote from Thoroughbred Associates

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Thoroughbred
Associates

E-mail: awinkie@thoroughbred
associates.com

Phone: 1-502-245-7841
Fax: 1-502-245-3811
Toll Free: 1-800-219-8211

Employee Benefits Insurance
Quotation Form
One Simple Form - takes only 2-3 Minutes!

Your Personal/Group Data:

Your Name:

Your Business Name:

Street Address:

City:

State:

MUST be Kentucky!

Zip Code:

E-Mail (REQUIRED):

E-Mail again for accuracy:

Phone:

Fax (optional):

Group Details
(If more than 5 in group, contact us.)

Employee #1 Name

M/F

Age

Status

Occupation

Salary

Currently Insured?

Plan type

$

Employee #2 Name

M/F

Age

Status

Occupation

Salary

Currently Insured?

Plan type

$

Employee #3 Name

M/F

Age

Status

Occupation

Salary

Currently Insured?

Plan type

$

Employee #4 Name

M/F

Age

Status

Occupation

Salary

Currently Insured?

Plan type

$

Employee #5 Name

M/F

Age

Status

Occupation

Salary

Currently Insured?

Plan type

$

Currently Insured?
(If yes, list carrier, and # of years
continuous. If none, type N/C)

Employee Health Problems?
(Do any of your employees have special health problems or insurance needs? If no, write "none".)

Group Benefit Plan Needs?
(Tell us what features you want in your benefits plan so that we may get the coverage and benefits you are looking for!)

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Group Insurance Quote NOW!

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