Fleet Insurance Shawn Logan Insurance

610 E. Main Street

Othello, WA  99344

Phone:  800-393-7616

Fax:  509-488-0558

E-mail:   slogan@sloganins.com

 

 

 

 

 

 

 

 

Group Medical/Health Insurance

 

Group health insurance is available for even the smallest companies at competitive rates. Coverage ranges from the bare minimum, to full medical, dental, vision, disability, and life insurance.
 

 

Group Medical Quick Quote

 

Business Name:  

 

Mailing Address:  

 

Business Telephone:            

Fax Number:  

Website Address:  

Contact Name:  

Cell Phone:  

E-mail address:  

 

What kinds of insurance are you interested in providing for your employees? Please check all that apply.

  Medical

  Dental

  Vision

  Disability

  Accidental Death & Dismemberment

  Term Life

Who is your current coverage with? 

 

Please fill out the employee census below. If you have more than 10 employees, you may fill out this form several times and click submit each time. We can then compile the information at our office.

 

Last, First MI

Date of Birth

Insure

Spouse?

Number of

Children?*

 

*Note that for the purposes of insurance, children must be legal dependents of the employee and must be under the age of 18 unless they are in school full time. Proof of attendance at an accredited school may be required.

 

               

After pushing the submit button you should see a confirmation screen showing the information you have sent to us. Please check it over and e-mail us with any corrections.

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