"An employee owned company"

Richards Benefits & Financial Services Form

Name:

Email Address:

Phone Number:

City/State:

I am an employer looking for information on the following type(s) of insurance:

EMPLOYEE BENEFITS
HEALTH
LIFE
TRAVEL
LONG TERM CARE
DISABILITY
ANNUITIES
FUNERAL TRUST

I am an individual looking for information on the following type(s) of insurance:

HEALTH
LIFE
ANNUITIES
TRAVEL
LONG TERM CARE
DISABILITY
FUNERAL TRUST

I currently have this type of insurance

YES
NO