Info Request

Pro144.com - Protecting your assets 

 

INFORMATION REQUEST FORM

John Salicco                                                                          Return to Home Page

 Independent Insurance Agent
Office Phone: 206-497-0049                                                                       

 

So that I may better serve you, please tell me a little about your present situation.

Please provide the following basic information as applicable.

      * Indicates a required information field.      

*Name:  
Title:  
*Phone:  
Company Name:  
* Street Address:  
Address (cont.):  
* City:  
* State:  
* Zip/Postal Code:  
No. of employees:   (If applicable)
   
* E-mail:  

When is the best time to reach you Monday through Friday.

         Mornings     After noon                                       

Please tell me about your primary area(s) of interest.  Check all that

         Personal needs            Business needs             

         Lowering company expenses  or FICA taxes

         Long Term Care options or the "CLASS Act"

         Disability Insurance - personal or for select executives and/or employees  (Executive Carve Out).   
                                      

What are your greatest personal concerns?

          Using tax advantaged assets instead of taxable funds to pay for Long Term Care

Controlling my company's or my practice's insurance costs

Estate or asset protection for myself and/ or employees

 Better safe return than a CD - Annuity information or rate quote
 

Briefly, tell me about any other interests or concerns you you would like to discuss.


 

With an independent agent, you have more choices.
NOTE:  I respect your privacy.  I will not add your email address to any other lists or provide any information about you to a third party.
 

 All rights reserved.
Revised: 09/03/10