Get a Quote for Insurance

Affincon is here to help your with all your group health insurance needs. Please complete the form below and an agent will contact you shortly to consult with your about the group health plan for your company.

Group Health Insurance Quote Form

Fields marked by an asterisk (*) are required fields.

Company Information

Company Name:*      Tax ID: 
Type of Business:*
SIC #:   
Years in Business:*  
Number of Employees:*  

Contact Information

Contact Name*
Address   Unit/Apt/Lot #  
City   State     Zip  
Contact Phone   Fax 
Best Time to Call

Requested Coverage Information

Health Coverage Requested:      
Effective Date Requested

Current Coverage Information

Current Coverage: 
Current Carrier: 

Employee Information

Name DOB Sex Smoker Zip Code Coverage Requested

The protection of your privacy is important to us. Rest assured that the personal information you provide us with will not be disclosed to other parties and will be used solely for the purpose of bringing you the best service possible.
Life insurance

""I can recommend Ron Dutton, without reservation, as an expert in helping to find the best and most affordable insurance coverage available. Mr. Dutton helped me untangle the enormous mountain of information I received as I became eligible for Medicare. He listened carefully to my needs and concerns and used his exceptional expertise to advise me concerning my new coverage needs. Mr. Dutton is not only an expert in his field he is a man who can be trusted.""
Janet Love
Lawrenceville, GA