Applicant Information

First Name:

Last Name:

Address:

City:

State (New York, CT or NJ):

Zip Code:

Daytime Phone:

Cell Phone:


Email:  (Required)


How Best To Contact You:


Currently Insured:



Disability Insurance Information

Date of Birth:

Gender:

Height:

Weight:


Do You Smoke:


Currently Own Disability Insurance:


Type of Disability Insurance Owned:


Monthly Gross Income:
$

Occupation or Title:


Explain Job Responsibilities:


Are you a government employee:


Are you a business owner:




Disability Coverage Information

Length of Coverage Needed:


Disability Coverage For:


Type of Coverage Needed:


Monthly Benefit Amount Desired:


Or Enter a Different Monthly Amount:
$

Benefit Period:


Elimination Period:


Payment Mode:



Explain any prior workers comp
or serious health issues below:




Question or Message:




Click the "Submit Quote Request"
button below to send your New York
Disability Insurance request to
Direct Access Group Benefits.


***By submitting this request you
acknowledge that this is neither
an offer to insure nor a guarantee
of insurance.***


            





We are a Somers, NY insurance
agency offering affordable New York
disability insurance quotes in the
following towns, cities and counties
in the Westchester County, NY area:
Port Chester, Harrison, Mamaroneck,
Larchmont, New Rochelle, Yonkers,
White Plains, Rye Brook, Scarsdale,
Rye, Ardsley, Hartsdale, Bronxville,
Mount Vernon, Irvington, Valhalla,
Elmsford, Dobbs Ferry, Hastings
on Hudson, Greenburgh, Tarrytown,
Sleepy Hollow, Hawthorne,
Scarborough, Thornwood, Briarcliff
Manor, Ossining, Harmon, Montrose
Crugers, Buchanan, Peekskill, Millwood,
Pleasantville Armonk, Chappaqua, North
Castle, Mt. Kisco, Bedford, Pound Ridge,
Bedford Hills, Cross River, South Salem,
Yorktown Heights, Goldens Bridge,
Amawalk, Yorktown, Katonah, Salem
Center, Somers, North Salem, Croton
Falls, Jefferson Valley, Shrub Oak,
Palisades, Sparkill, Tappan, Orangeburg,
Pearl River, West Nyack, New City,
Nanuet, Chestnut Ridge, Montebello,
Suffern, Monsey, Spring Valley, Congers,
Nyack, Rockland Lake, Wesley Hills,
New Hempstead, Pomona, Sloatsburg,
Ramapo, Hilburn, Willow Grove, Mt. Ivy,
Thiells, Tomkins Cove, Ladentown,
Haverstraw, Stony Point, Tomkins Cove,
West Haverstraw, Bear Mountain, Jones
Point, Newburgh, Middletown, Bronx,
New York City, Brewster, Poughkeepsie,
Putnam County, Orange County, and
Rockland County, New York.
In addition to Disability
Insurance, we also offer
affordable Health Insurance
policy premiums or choose
another New York, CT, or NJ
family insurance coverage
from the list below.
Direct Access
Group Benefits, Inc.
189 Route 100, PO Box 590
Somers, New York 10589
Westchester County, NY
Toll Free: 1-800-498-1819
Office: (914) 276-6000
Fax: (914) 401-9319
Contact Us Today!
Website Builder & Managed by InsuranceWebsiteServices.com
Copyright 2004-2020 Direct Access Group Benefits, Inc. - All rights reserved
DIRECT
ACCESS
GROUP
BENEFITS,
INC.
Employee Benefits Specialists
Call Us 1-800-498-1819
With more than 20 years of offering affordable group insurance services to both large
employers and small business throughout New York, Connecticut, and New Jersey.
We're an independent insurance agency and therefore able to consistently offer cost
effective life insurance coverage which is driven by a total commitment to service.
Personal
Insurance Quotes
Disability
Insurance Quote

Disability
Insurance Quote
Somers, New York Area
Westchester County, NY