CT Employee Life Insurance Quote Connecticut

**Information received from this Group Employee Life Insurance quote request form
sent to the William Malloy Insurance Agency will be for our use only and will not be
sold, given to or distributed to any other parties. A quote will be based on the
employee life insurance policy plan information provided and does not guarantee
acceptance of the risk by us. The precise coverage afforded is subject to meeting
underwriting guidelines, and the terms, conditions and exclusions of the policy as
issued. By submitting this request you acknowledge that this is neither an offer to
insure nor a guarantee of insurance. Completion of this form does not entitle your
Connecticut business to an Employee Life Insurance policy. We are licensed in
Connecticut and will not provide quotes for other states.

We are your local Fairfield County insurance agency, offering affordable
business group life insurance plans and services in the following Connecticut
cities and counties: Stamford, Norwalk, Greenwich, Darien, Riverside,
Belltown, Springdale, Round Hill, Old Greenwich, East Norwalk, New Canaan,
Glenville, Byram, Cos Cob, Mianus, North Stamford, Glenbrook, Wilton,
Weston, Long Ridge, Noroton, West Norwalk, Westport, High Ridge,
Southport, North Wilton, Winnipauk, Cannondale, Turn of River, South Wilton,
Lyons Plains, Georgetown, Ridgefield, Branchville, Redding, Topstone,
Ridgebury, Redding Ridge, Branchville, Dodgingtown, West Redding, Titicus,
Hattertown, Bethel, Danbury, New Fairfield, Newtown, Hawleyville, Botsford,
Monroe, Bridgeport, Stepney, Shelton, Huntington, Upper Stepney, Long Hill,
Trumbull, Stratford, Easton, Fairfield, Greenfield Hill, Stratfield, Nichols,
Oronoque, Rivercliff, Devon, Lordship, and East Bridgeport, New Haven,
Hartford, Torrington, Waterbury, Meriden, New Britain, New London, Norwich,
Manchester, East Hartford, Suffield, Granby, West Haven, West Hartford,
Branford, East Haven, Hamden, Woodbridge, Orange, North Haven, Groton,
Rocky Hill, Newington, Wethersfield, Glastonbury, Bloomfield, Blue Hills,
South Windsor, Naugatuck, New Hartford, Chesire, East Lyme, Old Mystic,
Wallingford, Southington, Middletown, Bristol, Laurel Beach, Litchfield,
Pleasure Beach, Mystic, North Westchester, Double Beach, Willimantic,
Storrs, Canaan, East Windsor, Vernon, South Canaan, Putnam, Guilford,
Windham, South Britain, Willington, Windsor, East Hampton, Brooklyn,
Westchester, and everywhere else in New Haven County, Litchfield County,
Middlesex County, New London County, Hartford County, Tolland County and
Windham County, CT.

In addition to Group Life
Insurance for your
Connecticut business, we
also offer affordable
Employee Health
Insurance plan premiums
or choose another CT
business insurance
coverage from the list
below.

We provide affordable Group Life Insurance services to businesses in Connecticut!

Group Term Life Insurance Coverage Information:

Employee Information:

Business Name:
Premises Address:
City:     State:     Zip Code:
Contact Name:
Phone #:    Ext #:
Fax:    Years in Business:
Email Address: (Required)
Description of Operations or SIC code:

Current Insurance Company:
Policy Expiration Date:          (mm/dd/yyyy)

Group Term Life Insurance Objective:
Amount of Life Insurance Desired Per Employee:    Other Amount:$

How many employees to be insured:

Did any employee to be insured have health problems during
the past 18 months?
If "Yes", please list information below.

Does any employee to be insured have a hazardous job? Yes No
If Yes, how many have hazardous jobs?

Are any employees to be insured active members of the military reserves? Yes No
If Yes, how many are active members of the military reserves?

Additional Information or Comments

Click on the "Submit Quote Information" button below to send
your Connecticut Group Life insurance quote request.**

Connecticut Business Information: