Thread View: misc.entreprepreneurs
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Started by Ray Stark
Sun, 30 Jul 1995 00:00
Health Care - California Residents Only - Blue Shield
Author: Ray Stark
Date: Sun, 30 Jul 1995 00:00
Date: Sun, 30 Jul 1995 00:00
27 lines
2035 bytes
2035 bytes
Affordable Health Care Coverage: Blue Shield of California.
CALIFORNIA residents only. For a free quote complete form below
and email to: raystark@wco.com
HEALTH CARE QUESTIONNAIRE
DATE __ TYPE OF QUOTE DESIRED: HMO ___PPO ___BOTH ___
FIRST NAME _ LAST _
ADDRESS __
CITY, STATE, ZIP ___
COUNTY ___ PHONE ___
FAX ___ E-MAIL __
AGE __ MARRIED __ SINGLE __
FAMILY COVERAGE:
SPOUSE NAME __ AGE __
CHILDREN: NAME AGE
_________ ________
_________ ________
_________ ________
_________ ________
Stand alone Dental and Vision plan info: __ Yes __ No
Contact Ray Stark at:
Pinole Insurance Services, Inc.
1660 San Pablo Ave #201 Pinole CA 94564
ph 510.741.8729 fax 510.741.7062
email: raystark@wco.com
http://www.wco.com/~raystark/
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