Fill out the following form to get started on a quote for your business.

Legal Company Name *
Legal Company Name
Address *
Address
Phone *
Phone
Are employees currently covered by WCB? *
Do you currently have group benefits?
Benefit Needs
Select the benefits you require
Benefit Selection : Employee Life AD&D
Flat:
Salary
Dependant Life
Weekly Income
Weekly Max:
Benefit Period:
LTD Benefit:
Elimination Period
Dental
Basic:
Major:
Maximum:
Ortho
Extended Health Care
Drugs
All Other Services
Vision