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Request A Quote

To obtain a Health Insurance Quote, copy of our Benefit Summaries, and Application Packet, please complete the following form.

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Please fill out the relevent values.
Individual
Gender
Birthdate (mm/dd/yy)
Applicant
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Spouse
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Child
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Child
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Child
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Child
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Child
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Please contact us directly if you have more than five children.
If applying as a business with two or more Full Time Employees, please download and complete the Employee Census Form. Then, fax or mail it to us at:

Gladle and Associates
PO Box 6487
216 Washington Street
Watertown, NY 13601
Fax: 315.782.5716

Once we receive a properly completed census, a representative will contact you within three business days.
All coverages may not be available in all states.