Indie Insurance

Contact us today for an Employee Benefits Quote. We handle Group Health, Group Life, Group Disability, Group Dental and Vision. (*All fields are required)

Legal Name of Business:

Your Full Name:

Your Position/Title:

# of Owners/Partners:

# of Full-Time Employees:

# of Part-Time Employees:

# of Sub-Contractors:

Legal Entity (LLC, Partnership, S Corp, Etc.)

Years in Business:

Annual Revenue (Under 100K, 100K-500K, Etc.)

4-Digit SIC Code: Need Help?

Day Phone (123-456-7890)

Cell Phone (123-456-7890)

Business Address (123 ABC St., Los Angeles, CA)

Zip Code:

Email Address:

Indie Insurance