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If you have any questions regarding the status of your quote request, please contact the quoting department:

Email: quotes@resourcebrokerage.com
Phone: 847-605-1200

*Required Fields

Broker Information
First Name: *
Middle Initial:
Last Name: *
Email: *
Phone: *
Alternate Number:
Preferred Method
to Receive Quote: *

Company Information
Desired Effective Date of Coverage:  (M/D/YY)
Company Name: *
Type or Description of Business: *
Main Business Address:
Zip: *
County: *
Main Business Phone: *
Note: We will never call your client, the phone number is required
for BC/BS and Humana data entry/filing/SIC code purposes ONLY!
Number of Business Locations Applying

Group Information
Medical Carriers: *
Ancillary Carriers:
Product Options: *