Request For Proposals

Please click on the appropriate form listed below. Once completed, hit SUBMIT and it will be sent directly to us.

Individual Short Term Disability Coverage

This form is for all Individual Short Term proposals.

Launch Form

Individual Long Term Disability/ Business Overhead

This form is for all Individual Long Term Proposals and all Business Overhead Expense cases.

Launch Form

Buy Sell Proposal Request

This form is for Buy / Sell monthly, down payment, or lump sum benefit amount proposals.

Launch Form

Multi-Life Offer Request Form

Use this form for cases with three or more lives and for which you would like to propose an executive carve out program, a retirement completion program, a group supplement program, or other type of multi-life disability income benefit program. This form will allow us to negotiate/request Guarantee Issue or Simplified offers from the insurance carriers. Additionally, a census in an Excel Spreadsheet is required including:

  • Company Name and Address
  • Employee Name (First, Last)
  • Sex
  • DOB
  • Resident State
  • Occupation
  • Salary
  • Bonus/ Commission

Download our pre-formatted Excel spreadsheet census form

Once completed, you may attach the census to the web form, or you can e-mail census to [email protected].

Download Excel Census Form Launch Form

Please feel free to contact us at 800-945-9719 to discuss the case, underwriting concerns, program design, and competition and carrier selection.

General turn around time is within 24 hours for most Individual / Business Overhead and Buy-Sell requests.

Please allow additional time for Multi-Life requests.