Long Term Care Questionnaire


Thank you for considering Equinox Financial & Insurance Services for your Long Term Care quote. Please complete and send us this simple on line form letting us know when you would like us contact you to gather the information we'll need to provide you with an accurate and individually tailored insurance quote. Now representing over 30 different Insurance Companies, Equinox Financial & Insurance Services provides you access to more Insurance Companies, Better Rates and More Choices than almost any other person anywhere in Maine. Please also read our Privacy Statement

NOTE: You do not need to be a credit union member to obtain a quote.

 * = required field

Your Name:


  
Preferred Call Back Time: (8AM until 6:30PM Mon-Fri)


If you already have an existing policy, please be sure to have it available at the time of our arranged call back.

Telephone Number:


Address (i.e. Street/PO Box City, State, and Zip code)


Email Address
 

Policy or Policies you would like to have quoted:
Personal Auto Policy
Homeowners Policy
Renters Policy
Rec Vehicles (ATV - Snowmobile - Jet Ski)
Watercraft and Boat
Personal Umbrella
Condo
Business and Commercial
Long Term Care
Other

Credit Union

Credit Union Affiliation is *NOT *required to secure Insurance quotes or coverage from Equinox. Equinox product and services are available to non Credit Union Maine Residents or to Non residents with physical properties located in Maine. Equinox does not write insurance for properties not located in Maine or auto insurance for drivers not licensed in Maine and not living in Maine.

 
The information you have provided will be kept confidential and will only be used to obtain quotes for your insurance.  Someone from Equinox Insurance will contact you shortly.