*Indicates required information

Section A: Employee Information

Are any of your employees seasonal or part-time?

Are all eligible employees participating in plan?

Are any employees absent from work due to disability, maternity or leaves of absence?

Are your employees covered by Workers Compensation?

Please rank the following benefits in terms of their importance for your plan:

Life Insurance:

Least           Most

Extended Health Care :

Least           Most

Vision Care :

Least           Most

Dental Care :

Least           Most

Short-Term Disability :

Least           Most

Long-Term Disability :

Least           Most

Critical Illness Insurance:

Least           Most

Section B: Company Information

Has your company ever had
an Employee Benefits Plan?

If yes, what company? 

Expiration Date:

Name of Business:*

First Name:*

  Last Name:*

Job Title:*

Address:*

 City:*

Prov:*

Phone:*

Fax:

Horizon Planning Group Inc. values your business and we thank you for your confidence in choosing our firm as your source of advice and products. As our client, you trust us with your personal information. We respect that trust and want you to be aware of our commitment to protect the information you share in the course of doing business with us.

To learn more, please read our entire Privacy Policy.

* Yes, I agree to Horizon Planning Groups use of my above personal information to obtain my requested quotation.