The Metropolitan Agency Serving the Tri-State Area:
New York - New Jersey - Connecticut
Call Us: (914) 275-1160 Call Us: (914) 275-1160
Fax: 845 227 3465

One Company, Endless Solutions

The Metropolitan Agency provides Personalized Insurance and Risk Management Solutions in the
New York Tri-State Area.

Quick Quote
The Metropolitan Agency The Metropolitan Agency
BBB - Accredited Business
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Commercial Auto Quote Request

Please take a moment to fill out the form below and one of our local insurance agents will contact you with a free, no-obligation quote. This information will be kept confidential and will be used for quote purposes only.

 

General Information
Legal Name of Business:
Full Name:
Address:
City:   State:   Zip:
Business Phone:   Fax:
Best Time To Call:   AM   PM
Contact Email Address:


Type of Business
Type of Business:
Standard Industry Code (if known):
# of Full Time Employees:         # of Part Time Employees:
Give a complete description of any
type of hazardous/dangerous duties
performed by your employees:

 

Current Group Health Insurance Information
Carrier (Company) Name (not agency):
Please give a brief description of your current Group Health plan:


Benefits Desired
Major Medical Deductible:     Optional Pregnancy Coverage: yes   no
Dental Coverage: yes   no Supplemental Accident Coverage: yes   no
Disability Insurance: yes   no PCS Card:
(Prescription Discount Option)
yes   no
Group Life Insurance:

 
Amount:

yes   no

$

PPO Option: yes   no
HMO Option: yes   no


Employee Information
Please list all employees you wish to cover:
Employee Name
Date of Birth
Age
Sex
Dependent Status
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
If you were unable to list all employees you wish to cover in the spaces above,
please use the Additional Comments section below
or indicate that you will fax or email an additional listing.


Additional Comments
Please make any additional comments you feel appropriate for this quote.

  Enter Security Code:
 


Please click on the "Submit Quote" button to send your quote request.
One of our representatives will respond to your submission as soon as possible.

 

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