Washington State Health Insurance, Michael Benzikry & Associates
 
Disability Insurance Quote
QUICK QUOTE
Group Benefits
Individual Health
Short Term Medical
Dental Insurance
Disability Insurance
Life Insurance
Longterm Care
 
Man on the phone
 
 
We make every effort to respond within 1-2 business days.
*Indicates Required Field
   
*Name
*Address
*City
*Zip
*Email
*Phone
*Best time to contact:
  Insurance to cover:
  Amount of insurance requested
  Profession
  Currently insured? No Yes
  Name of Company
  Current Premium
 
Gender
Age
Height
Weight
Occupation
*Applicant
M F
Spouse
M F
Anyone using tobacco products? If so, who?
 
Anyone with major health problems? If so, who and what?
 
Anyone taking any medications? If so, who and what?
 
Comments, questions or special needs:

 

Thank you for your inquiry!

 

 

Michael Benzikry & Associates, 9311 SE 36th Street #105, Mercer Island WA 98040 | Call (206) 232-1080
©2009-2015, Michael Benzikry & Associates. All Rights Reserved.