Home About Us Directions Resources Individual
65+ Plans
Contact Us

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 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 with the price quote  from one or more companies. We may call you if we need to clarify or obtain any additional information. We represent many companies and want to offer you a plan that meets your needs.

Senior Plan Quote Request Form

How did you hear about us?
Friend, Yellow Pages, Yahoo, Google etc...

Please Send Quote for: Medicare    Long Term Care   Prescription Plans
                    Coverage for: Self    Spouse    Parent    Friend

*Contact Person

Street Address
State, Zip    
Daytime Phone
Evening Phone
Contact by email     phone

Additional Notes:

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