Middleton & Company Insurance - Health, Life & Employee Benefits Quote

p. 973.383.5525 f. 973.383.9602 info@middletonins.com

Health, Life & Employee Benefits Quote

Personal Details

Company Name:
First Name:
Last Name:
Email:
Phone:
Address:
City
State
Zip Code




Tax ID Number:
SIC Code:
Individual Plans Number:
Family Plans Number:
Employer Contribution:
Number of COBRA Participants:
Number of Employees:
Number of Full-Time Employees:
Number of Covered Employees:
Number Waived:
Probationary Period (Days):




Census – RATES/Current ($)

EE Employee Only:
EE Employee +1:
EE Employee + Spouse:
Full Family:

Please provide us with a copy of your current plan design, current rates, and an employee census. You can either email or fax them to the following:

email: cindy@middletonins.com

Fax: 973-383-9602

*Disclaimer: Communication with this page does not imply or constitute insurance coverage.

"How you make your money is YOUR business. How you protect it is OUR business."