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This should contain all the fields previously entered by the member. Information request will be emailed to
Sally@barnettandassociates.net, Cathy@barnettandassociates.net
TO REQUEST INFORMATION
, please be sure the information below is correct:
Name
Telephone
Social Security Number
Fax # (if applicable)
Date of Birth
Email
ILA Local #
ILA Local #
Address
Preferred Method to contact you:
Phone
Email
Mail
If by Phone, preferred time to contact you:
9AM-12PM
12PM-5PM
5PM-7PM
What Type of coverage are you interested in getting:
On the Job Accident
Off the Job Accident
Sickness Disability
Life Insurance Dental
What monthly benefit amount are your looking to get?
What amount are you looking to spend per week for coverage (approx)?
What amount of coverage are you looking for?
Burial Protection?
Certain Amount?
