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Strategic Insurance Services
101 Metro Drive, Suite 315
San Jose, CA 95110

Phone: (408) 878-6052
Efax: (408) 521-2223
 
Strategic Insurance manages individual Life, LTD, STD & LTC plans. For a quote, please provide the following information.
 

Individual Life, LTD, STD & LTC Inquiries

Use the "Notes" field if needed.

"*" indicates required information.

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For what product would you like a quote? Check:

 

Privacy Policy: We will never offer your contact data.

 

 

 

Name:    
Date of birth:
Address (home zip code only)
Phone:
Fax:
Email:
Smoker: Yes: ________   NO: ________    
   
What would you like to quote for:  
  LIFE: _________ Long Term Care: _________  
    
  Long Term Disability : _________  Short Term Disability : _________   
   
What is the effective date that you are requesting: _____ - _____ - _______  
                 

 

 

 

 

 

 

 

 
Strategic Planning for your Insurance Needs


CA Insurance License # 0495737

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