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Request for MA Health Connector Group Insurance Quote

Mid-State Insurance has many options for companies wishing to provide their employees with group health, dental, disability, and life insurance.  If you would like to obtain a quote for your business please submit the form below and an employee census.  Click here for a blank census form.  You will need Adobe Acrobat Reader© to receive the census form.  You may download a free copy from Adobe©.

Complete the form, and then let us know how to contact you.

MA Health Connector Request
Name
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
FAX
# Employees
E-mail

 

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Bears on Board

Mid-State Insurance Agency, Inc. is proud to sponsor the local Bears on Board program for Bears on Board Inc. Click here to learn more.
Securities are offered through registered representatives of Sammons Securities Company, LLC.  member FINRA(www.finra.org) & SIPC.  Securities activities are supervised from a Sammons Securities Company branch office at 4261 Park Rd., Ann Arbor MI  48103.  Mid-State Insurance Agency, Inc. is independent of Sammons Securities Co.
37 Mechanic Street - Worcester, MA 01608
Phone: 508-791-5566 | Fax: 508-755-8720		 Copyright Mid-State Insurnace Inc. 2005
All Rights Reserved