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We will present you with price and benefit information from the best  plans available here in New Hampshire.  There is absolutely NO OBLIGATION whatsoever.  This information will be kept confidential.

Instructions: In order to receive your FREE Health Insurance Quote, simply fill in ALL of the requested information below.  Then press the "Submit" button at the bottom of the form. 
We will review your request within 24 hours and contact you by email or  regular mail  or we may call you if we need to clarify or obtain any additional information. Due to recent changes in New Hampshire insurance  law (sb110) , in order to get you an accurate quote we may have to ask some further questions about your business.  We represent many companies and want to offer you a plan that meets your needs. 


Group Disability Insurance Quote Request Form

How did you hear about us?
Friend, Yellow Pages, Yahoo, Google etc...
*Company Name
*Contact Name
Type of Business
Street Address
State, Zip    
Full Time Employee Status (Include only FTE's enrolling on the plan )
Note: If more than five employees, please fax a census to 603-647-4537
Employee  DOB Status
Employee #1
Employee #2
Employee #3
Employee #4
Employee #5

Does your company currently have Health Insurance?

Yes       No
Are you also interested in a group quote for Dental   Health  Life

Additional Notes:

Allen Associates
1340 Bodwell Rd., Manchester NH 03109
Phone: 603-625-2266    Toll Free: 800-323-0203    Fax: 603-218-6588