Mark Garetz, CSA
Insurance Specialist
Certified Senior Advisor

Life Insurance - Health Insurance - Annuities - Long-Term Care Insurance - Disability Insurance - Homeowners Insurance - Auto Insurance

Serving the Tri-Valley Area: Danville, Blackhawk, San Ramon, Dublin, Pleasanton, Alamo, Walnut Creek and Livermore



Disability Income Insurance Quotes

Please fill out the following information to the best of your ability.  The more accurate this information is, the more accurate a quote I'll be able to give you.  Many agents believe that the way to get your business is to "low-ball" you by giving you a quote that's well below what you would actually get when you receive the policy.  I don't play this game.  I always try to get you the most accurate quote possible so there are no surprises later.  Please note that I will always quote you for the maximum benefit they will pay per month (this is based on your salary).  You can choose a lower benefit and lower the premium.

* denotes a required field

Your First Name:*    Your Last Name:*

Your street address:*

Your city:*   Your State:*   Your Zip Code:*

Your daytime phone number:*

Your evening phone number:

Best time to call (if necessary): Anytime  Morning Afternoon  Evening

Your email address:*  

Your email address:*   (retype)

Do You Currently Have Disability Insurance?: Yes  No

If yes, who are you currently insured with?:

Are you a:  Male  Female *

What is your birth date?* (mm/dd/yyyy)   /     /  

Height:*    Weight:* 

What is your annual salary? * 

What is your occupation? *   (the more specific the better)

Do you want inflation protection?  Yes  No

Length of benefit desired?*

Time before benefits start?*    (longer time = lower premium)

When did you last use any tobacco products?*

Any other comments or questions?

No High Pressure, Ever!

2248 Camino Ramon
San Ramon, CA  94583
CA License #0E08278