MD Group Life Insurance Quote

We are your local Washington D.C. area full service insurance agency,
offering comprehensive group life insurance plan services to large and small
businesses located in the following cities and counties: Wheaton, Silver
Spring, Bethesda, Aspen Hill, White Oak, Takoma Park, Randolph Hills,
Veirs Mill, Kensington, Kemp Mill Estates, Rock Creek Forest, Chevy
Chase, Woodmont, Garrett Park, Oakmont, Calverton, Fairland,
Springbrook, Glenmont, Foxhall, Layhill, Colesville, Meadowood, Rockville,
Laurel, Gaithersburg, Good Hope, College Park, Greenbelt, Montpelier,
Adelphi, Langley Park, Berwyn Heights, Knollwood, Beltsville, Maryland
City, Riverdale, Hyattsville, Chillum, Lewisdale, University Park, New
Carrollton, Landover Hills, Bladensburg, Cheverly, Kent Village, Somerset,
Chevy Chase View, Glen Mar Park, Westgate, Brookmont, Luxmanor,
Montrose, Potomac, Glen Hills, Derwood, Washington Grove, North
Potomac, Redland, Olney, Sandy Spring, Norwood Corner, Ashton, Ednor,
Spencerville, Burtonsville, Good Hope, Fulton, Savage, Bowie, Crofton,
Kettering, Forestville, District Heights, Capitol Heights, Columbia, Annapolis,
Germantown, Brinklow, Brookeville, Highland, Simpsonville, Brighton,
Clarksville, Laytonsville, Damascus, Dayton, Unity, Glenelg, West
Friendship, Seneca, Dawsonville, Poolesville, Towson, Baltimore,
Montgomery County, District of Columbia, Prince Georges County, Howard
County, Anne Arundel County, and Baltimore County, MD. We also offer
group life insurance plan coverages for your small business if it's located in
the state of Maryland or northern Virginia, including Arlington, Alexandria,
McLean, Falls Church, Annandale, Reston, Fairfax, Vienna, Herndon,
Sterling, Leesburg, and Manassas, VA.

Business Name:
Premises Address:
City:
State: (Maryland, Virginia or District of Columbia)
Zip Code:
Contact Name:
Phone #:    Ext #:
Fax:    Years in Business:
Email Address: (Required)
Description of Operations or SIC code:

Current Insurance Company:
Policy Expiration Date:          (mm/dd/yyyy)

Group Term Life Insurance Coverage Information:

Group Term Life Insurance Objective:
Amount of Life Insurance Per Employee:    Other Amount:$

Employee Information:

How many employees to be insured:

Did any employee to be insured have health problems during
the past 18 months?
If "Yes", please list information below.

Does any employee to be insured have a hazardous job? Yes No
If Yes, how many have hazardous jobs?

Employees to be insured active members of the military reserves? Yes No
If Yes, how many are active members of the military reserves?

Additional Question or Comment:

Click on the "Submit Quote Information" button below to send
your Maryland Group Life insurance quote request.**

**Information received from this Maryland Group Life Insurance quote request form sent to Brown Insurance Group, will be for our use only and will not be sold, given to or distributed to any other parties. A quote will be based on the group life insurance policy information provided and does not guarantee acceptance of the risk by us. The precise coverage afforded is subject to meeting underwriting guidelines, and the terms, conditions and exclusions of the policy as issued. By submitting this request you acknowledge that this is neither an offer to insure nor a guarantee of insurance. Completion of this form does not entitle your business to a Maryland Group Life Insurance Policy. We are licensed in Maryland, Virginia and the District of Columbia, and will not provide quotes for other states.