Bestplans Canada: Medical / Dental Quote Form

Medical / Dental Quote Form

Request a free Medical/Dental price quote comparison

If you are not self-employed, please complete our Individual Medical/Dental Insurance Form

Business Owner: Fields marked with an * are required fields.

You will also be required to enroll for In Province Medical/Travel Medical coverage for each employee covered by this flexsave account.

*Company:
*Address:

*City:		*Province:
*Postal Code:		Website:

Key Contact Information: (this person will be the main contact person for your flexsave account)

Salutation:
*First Name:		*Last Name:
*Telephone:		Fax:
*Email:

Enrollment Details:

Effective Date:	/ /
How would you like to receive your Registration documents?
How would you like to receive your Invoices?
How will payments be made to Hub Financial?
All employee claims will be paid by Electronic Funds Transfer (EFT). Click here for the enrollment form.
Would you like to use the Internet to manage your Account? Yes No

Comments:


Our Privacy Policy:

Horizon Planning Group Inc. values your business and we thank you for your confidence in choosing our firm as your source of advice and products. As our client, you trust us with your personal information. We respect that trust and want you to be aware of our commitment to protect the information you share in the course of doing business with us. To learn more, please read our entire Privacy Policy. * Yes, I agree to Horizon Planning Groups use of my above personal information to obtain my requested quotation.


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