Get A Quote

To enable the benefits specialists at Granville West to prepare a no cost quotation for your organization, we will require you to complete the following information. This will allow our professional team to properly assess your needs to develop a customized plan that will be suitable for your unique organization.

Contact Information

Contact Person
Company Name
Phone No.
Email Address
 

Benefits Coverage

How many employees work for your organization?
Do you currently have a Benefit Coverage? Yes No
What is the most important component to you when investigating a benefit program? Please rank from 1 (highest) to 6 (lowest)
  Cost
  Level of Coverage
  Flexibility in Coverage
  Simplistic Administration
  Attracting and Retaining Key Employees
  Cost Effective method of Compensation
 

Interest

Please indicate your level of interest in each of the following benefits on a scale of 1 to 10, with 1 being not at all interested and 10 being very much interested:

  1
low 		2 3 4 5 6 7 8 9 10
high
Life Insurance
Dependent Life
Optional Life
Accidental Death
Short Term Disability
 
Extended Health Care
Rx Drugs
Paramedical
Major Medical
Vision
Out of Country
Dental
Cleanings, Extractions, fillings
Root canal, gum disease
Caps, bridges, onlays/inlays
Orthodontia (braces) for kids
Braces for adults

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