Employee Benefits Insurance Quote

*What type of employee benefits coverage are you seeking? Click all that apply:

Health

Life

Vision

Dental

Disability

Contact Information

Please provide us with the following information. Fields marked with * are required fields.

*First Name:
*Last Name:
*Title:
*Phone:
*E-mail

Business Information

*Business Name:
*Address:
*City:
*State:
*Zip Code:
Web site address:
Best time to contact:

Employee Information

Please provide the following information for each employee to be enrolled or you can upload an excel spreadsheet below:

	Employee Name	D.O.B.	Depts.	HMO or PPO	Home Zip code
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Additional Information

Please provide a 3-4 sentence description of your organizations operations.

Testimonials

I´m amazed, you guys gave me better coverage and for less money than I was paying, you guys are great!

Anne C.
Pasadena, CA
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Binney, Chase & Van Horne has provided our company with continuous high quality service and value for our insurance needs for three generations.

D.E. Benjamin,
Benjamin Electric Company
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> Read More Testimonials

Binney, Chase & Van Horne, Inc.
600 S. Lake Ave. Suite 306 Pasadena, CA 91106
(626) 792-7654 - Outside of the 626 area, phone our toll-free number: 800-585-8787

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