Three Ways To Submit Your Request for a Quote:
- Complete this form on-line
- Print this form and fax it to us at (503) 968-2817
- Print this form and mail it to us
Note: To provide you a quote we need a census of all participating employees and their dependents.
Minimum census information required for a quote is:
– Last Name / Initial / Employee, Spouse or Dependant? / Birthdate xx/xx/xxxx
Here is the information we need to prepare your quote: