Get a Quote - Central Ohio Chambers of Commerce

Fill out the below form to receive a free quote for your company

First Name *

Last Name *

Company Name *

Job Title

Street Address *

City *

State *

Zip Code *

Day Phone *

Email *

Current Health Insurance Carrier *

If Other, Please Specify

How many employees do you have covered?

How many total employees do you have?

Current Monthly Premium

Business SIC or Description

Select Your Area

Are You a Chamber Member?

Yes No

Do you work with an insurance broker?

Yes No

If so, which one?

Where did you hear about this offer?

Are you interested in Consumer Directed Health Care programs?

Yes No

Central Ohio Chamber of Commerce
110 E. Wilson Bridge Rd. Suite 260
Worthington, OH 43085

Phone: 888.506.1574
Fax: 614.889.6129
Email: info@chamberhealthchoices.com