LIFE INSURANCE QUOTE

Please note that your inquiry about a quotation does not bind you to the acceptance of the quotation nor does it impose upon you the obligation to accept the quote for the purpose of creating a contract. The contract for insurance is not created until there is agreement by you in writing as to your acceptance of the coverages, premium cost and the conditions and provisions of the insurance wordings.

If you would rather speak to one of our sales representatives, please call us at 905-761-9645 - Toronto Line: 416-247-5471 - Toll Free: 1-888-343-5575

PERSONAL INFORMATION
NAME:
EMAIL:

PHONE:
CITY/TOWN:
POSTAL CODE:
How many years have you had life insurance? years months
How would you like us to contact you? email phone
Before submitting this quote request to our office, please leave us any comments you may have
(i.e. additional information on any of the above questions).

Please note that your inquiry about a quotation does not bind you to the acceptance of the quotation nor does it impose upon you the obligation to accept the quote for the purpose of creating a contract. The contract for insurance is not created until there is agreement by you in writing as to your acceptance of the coverages, premium cost and the conditions and provisions of the insurance wordings.

I have read and understand the above statement. To submit please type the word YES in this box:

 

Michael Palermo & Associates Insurance Limited
7501 Keele Street, Suite 501, Concord, ON, L4K 1Y2

Phone: 905-761-9645 - Toronto Line: 416-247-5471 - Toll Free: 1-888-343-5575
Fax: 905-761-9808 - Toronto Fax: 416-247-6914
info@palermoinsurance.com
 


Copyright © 2003, Michael Palermo & Associates Insurance Limited. All rights reserved.