Oregon church insurance from Salem Insurance AGency, Inc
Meeting the Commercial Insurance Needs of Oregon Churches for Over Three Decades!
 
Commercial and church Insurance from Salem Insurance Agency
Church Policy Quote

Property Insurance Quote

Church Liability Insurance

Directors & Officers Coverage

Clergy Counselling Insurance

Workers Compensation

Church Vehicle Insurance


Church group life and health Insurance Products from Salem Insurance
Group Life Insurance

Group Health Insurance


Other Church Insurance Services from Salem Insurance
Service My Account

More About Our Agency

Office Map/Directions

Our Privacy Notice

We offer you our Absolute Satisfaction Guarantee!
 Your Satisfaction is guaranteed!
 
 
Group Life Insurance
Quotation Form
One Simple Form - takes only 2-3 Minutes!
Your Personal Data:
 
Your Name:
Street Address:
City:
Click to Select State:
Zip Code:
E-Mail (REQUIRED):
E-Mail again for accuracy:
Phone:
Fax (optional):
 
If currently covered list carrier, # of years covered, and type of coverage

Underwriting Information:
 
List employees' names, and other census data:
(If More Than 10 Employees, place call us to
receive a large group census form.)

Employee #1 Name:B-Date: M/F:
Employee #2 Name:B-Date: M/F:
Employee #3 Name:B-Date: M/F:
Employee #4 Name:B-Date: M/F:
Employee #5 Name:B-Date: M/F:
Employee #6 Name:B-Date: M/F:
Employee #7 Name:B-Date: M/F:
Employee #8 Name:B-Date: M/F:
Employee #9 Name:B-Date: M/F:
Employee #10 Name:B-Date: M/F:


Coverages:

Amount of Coverage Desired?
 
Type of Coverage
(Term, Universal life, Other):
TERM = Pays death benefit only - This is lowest cost for coverage.
UNIVERSAL LIFE = Has savings aspect in addition to providing death benefit.
 OTHER = Would be mortgage protection, whole life, etc.
 
Years of Level Premium.
 
List Any Health Problems:
 
Reason for Buying Life Insurance:
 
Send my quotation via: E-Mail Fax
Regular Mail
Call Me by Phone

Thank you for filling out this form COMPLETELY!

We value your input as PRIVATE information. Every step has been taken to insure your privacy, security, and our intent is to release quote information only to you. We will not give your data to ANY other person or group for sales, marketing, or ANY other purposes. By checking the box below you agree to allow our agency to release this information via the method you have chosen, and to release us from any liability should this information be accidentally viewed by others. Our intention is to maintain your complete privacy.

Yes, I Agree. Please Send Me a
Group Life Insurance Quote NOW!

Click Button Below When Done

Please Click Only Once . . . May take up to 30 seconds!

Salem Insurance Agency, Inc. . Mailing Address: PO Box 888 . Salem, OR 97308
Toll Free Phone: 866-585-8001 . Phone: 503-585-8001 . Fax: 503-587-7811
Office Street Address: 4680 Commercial Street SE . Salem, OR 97302
Online Telephone Contact Hours are: 9:00 to 5:00, Weekdays | View Our Privacy Notice
E-Mail us at: info@saleminsagency.com | Website Design © 2012, Insurance Web Sales