Home About Us Directions Resources Individual Plans Group Plans Seniors 65+ Plans Foreign Travel 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.  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. Group Dental 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 City  State, Zip     *E-mail  *Phone Fax 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 Single (employee only) Couple (employee & spouse) Employee plus Child Family (employee,spouse,children) Employee #2 Single (employee only) Couple (employee & spouse) Employee plus Child Family (employee,spouse,children) Employee #3 Single (employee only) Couple (employee & spouse) Employee plus Child Family (employee,spouse,children) Employee #4 Single (employee only) Couple (employee & spouse) Employee plus Child Family (employee,spouse,children) Employee #5 Single (employee only) Couple (employee & spouse) Employee plus Child Family (employee,spouse,children)   Are you also interested in a group quote for Health   Disability   Life Additional Notes:

 
 ALLEN ASSOCIATES ~ Manchester NH 03109
603-625-2266 or 800-323-0203
Fax: 603-218-6588

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