NH Group Life Insurance Quote

Gorman Insurance and Risk
Management Services of
Somersworth, NH offers
affordable Commercial
Insurance coverage options
and experienced business
insurance services
throughout New
Hampshire, southern
Maine, and Massachusetts.

Contact us about Group
Health Insurance toll free at
1-800-678-3431, as well as
Group Disability Insurance
services for your NH, ME,
or MA business.

In addition to New
Hampshire Group Life
Insurance, we also offer
affordable Group Long
Term Care Insurance plan
services.

We are your local southeastern New Hampshire, southern Maine
insurance agency, offering experienced group life insurance services to
businesses located in the following cities and counties: Somersworth,
Durham, Portsmouth, Dover, Rochester, Rollinsford, Barrington, Madbury,
Lee, Strafford, Farmington, Milton, Barnstead, Nottingham, Northwood,
Raymond, Newmarket, Newfields, Stratham, Rye, Hampton, Epping,
Exeter, Salem, Danville, Deerfield, West Rye, Derry, Chichester, South
Barnstead, Gilmanton, New Durham, Wolfeboro, Alton, Laconia, Berlin,
Lebanon, East Candia, North Hampton, Hanover, Littleton, Plymouth,
Claremont, Newport, Keene, Hampton, Rye Beach, Strafford County,
Rockingham County, Hillsborough County, Merrimack County, and
Belknap County, NH. We also offer group life insurance services
throughout the state of New Hampshire, including the Manchester,
Nashua, and Concord area. Our service area in southern Maine includes
the following cities and counties: South Lebanon, Kittery, Eliot, Berwick,
Sanford, Blaisdell Corners, Springvale, Emery Mills, Wells Beach, York
Beach, Kittery Point, Kennebunk, Saco, Biddeford, Alfred, Portland,
Scarborough, Westbrook, Waterboro, Shapleigh, Newfield, Buxton,
Goodwins Mills, South Sanford, Cape Elizabeth, South Portland, York
County, and Cumberland County, ME.

Business Name:
Premises Address:
City:
State: (New Hampshire, Maine or Massachusetts)
Zip Code:
Contact Name:
Phone #:    Ext #:
Fax:    Years in Business:
Email Address: (Required)
Description of Operations or SIC code:

Current Insurance Company:
Policy Expiration Date:          (mm/dd/yyyy)

Group Term Life Insurance Coverage Information:

Group Term Life Insurance Objective:
Amount of Life Insurance Per Employee:    Other Amount:$

Employee Information:

How many employees to be insured:

Did any employee to be insured have health problems during
the past 18 months?
If "Yes", please list information below.

Does any employee to be insured have a hazardous job? Yes No
If Yes, how many have hazardous jobs?

Any employees to be insured active members of the military reserves? Yes No
If Yes, how many are active members of the military reserves?

Additional Question or Comment:

Click on the "Submit Quote Information" button below to send
your New Hampshire Group Life insurance quote request.**

**Information received from this New Hampshire Group Life Insurance quote request form sent to Gorman Insurance and Risk Management Services, will be for our use only and will not be sold, given to or distributed to any other parties. A quote will be based on the group life insurance policy information provided and does not guarantee acceptance of the risk by us. The precise coverage afforded is subject to meeting underwriting guidelines, and the terms, conditions and exclusions of the policy as issued. By submitting this request you acknowledge that this is neither an offer to insure nor a guarantee of insurance. Completion of this form does not entitle your business to a New Hampshire Group Life Insurance Policy. We are licensed in New Hampshire, Maine, Massachusetts, and will not provide quotes for other states.

New Hampshire Business Information: