Health Insurance for the Self-Employed
At Affordable Rates!



SERVING THE DALLAS/FORT WORTH METROPLEX AREA



Finally - a health insurance plan designed especially for the self-employed!

People in business for themselves share a common problem: Finding the kind of health insurance coverage they need at prices they can afford. This has been next to impossible until now.

Small business owners all across America said they wanted a health plan that:

  • Delivers what it promises, without surprises.
  • Allows you to choose your doctors and hospitals.
  • Is customized to fit individuals' personal needs at affordable rates - and that doesn't charge for unnecessary coverage.
  • Provides a toll-free number to answer questions and ensure that individuals maximize their coverage.
  • Gives prompt and courteous claims service, and processes timely payment of all claims.






    For details, including any exclusions or limitations of
    the coverage, contact Greg Gomes by completing the
    form below, by E-Mail or by calling 800-422-2004 Ext.8892.









    COMPLETE THIS FORM FOR ADDITIONAL INFORMATION AND QUOTATION



    Name:

    Address:

    City: State: Zip Code: -

    Business Phone: Home Phone:

    E-Mail Address:

    Are you self-employed? Yes No

    What is your business?

    Do you currently have health insurance? Yes No

    Who is your health insurance company?


    Family Members Information:
    1. Sex: Male Female Age: Smoker? Yes No
    2. Sex: Male Female Age: Smoker? Yes No
    3. Sex: Male Female Age:
    4. Sex: Male Female Age:
    5. Sex: Male Female Age:
    6. Sex: Male Female Age:
    7. Sex: Male Female Age:
    8. Sex: Male Female Age:


    Comments:





    © 2000 g_h_gomes@hotmail.com

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