CPS-Reliable Financial Group
Experts in Business, Estate and Personal Life Planning
A CPS Insurance Services, Inc. Affiliated Office
 
Home Page
About Us
Health Issues
Current News
Contact Us
E-Mail Us
NAILBA Guide
 
Advanced Marketing
Advanced Planning Videos
Advisys
Genworth Financial
ING Executive Benefits
JH Advanced Markets Radio
JH Key to Life
Pru Financial
Annuity
Annuity Information
Broker Dealer
Financial Services
Carrier On-Line Term
AVIVA
AXA Equitable - i-Go e-App
GLAIC - i-Go e-App
GLAIC - Life Quick Request
ING - i-Go e-App
Nationwide - i-Go e-App
Phoenix - i-Go e-App
Prudential - i-Go e-App
West Coast Life - TeleLife
Education
A Plus On-Line
United Insurance Ed
E&O Insurance
NAIFA
NAILBA
How To
Buy Low Cost E&O Ins
Register for Case Status Live
Register for the VitalSuite
Register for Winflex Web
Ideas to Grow With
Create a Website
Grow Your Business
Promotions
Honolulu, Hawaii
Quote Request
Pre-Quote Questionnaire
Annuity
Disability
Life Settlement
LTC
Permanent
Small Group
Term
Services
A.M. Best
AML Training
Apps & Forms
Case Status Live
Life Products
Links
Permanent Product Info
Policy Holder Services
Term Life Products Info
Software
VitalLTC
VitalSigns
VitalTerm
VitalUL
Winflex Web
i-Pipeline Term Quote
Specialty Products
Exceptional Risk
JH LifeCare
Life Settlements
Premium Financing
Underwriting
Health Questionnaires
NAILBA Guide
Order Paramed
Pre-Quote Questionnaire
Underwriting Guidelines
Webinars & Conferences
Webinars
Small Group Quote Request

The Small Group Quote Request Form is for companies and rganizations of up to 49 people.
Please make sure that you provide an accurate email and telephone number so that your CPS-Reliable CSR can contact you if additional information is needed to complete your request

Broker / Agency Information
Broker Name:
Agency Name:
Broker Address:
City:
State:
Zip Code:
Phone:
Email:
Fax:
License #:
Group Information
Group Name:
Requested Effective Date
(xx/xx/xxxx) California Groups Only
Zip:
Sic Code:
Nature of Business:
Quote Specifications (check all that apply)
Blind Quote: Yes No
Due Date: (xx/xx/xxxx)
Delivery Method: Email Fax Overnight Hold for Pick up
Type of Carveout:
RAF: Lowest Standard Highest
Census Information

Deps: EE=Employee Only  ES=Employee + Spouse  CH=+ One Child  FA=+ Family
Name
DOB
Gender
Deps
Zip
Cobra
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Additional Comments?
Please fill out all information completely and accurately.

 

 

 

 

 

 


All content is copyrighted and can not be used without express written permission.
Web site Created: September 2002
© 2002-2009 Reliable Financial Group, Inc. All Rights reserved.
Terms of Use and Disclaimer