Orange County Insurance Services

2-49 Small Groups

50-99 Medium Groups

100+ Large Groups

Census Form

Group Health, Dental, and Life Insurance

FILL OUT YOUR CENSUS FORM ONLINE | PRINT OUT OUR CENSUS FORM TO MAIL

To speak directly to our Group Department:
call (949) 542-0005

Experienced employers who want a no hassle quote on their health, dental, life & disability insurance just fax us your census and we will prepare your quote and contact you with the final proposals.

Fax: (949) 951-8476 e-mail: slinsurance@cox.net

Complete the form below for more information.

Contact Information

Business or Group Name: SIC Number:

Address to mail proposal: (If Desired)

Address Continued:

City: State:

Daytime Phone: Evening Phone:

Email Proposal To:

Zip Code: Looking for coverage to begin on:

List Of Employee Information:

Name Of Employee	Date of Birth	Zip Code	Spouse	No. of Children

Comments or Additional Information:

If you prefer, click on a link below to apply and research directly online.

Plus Many More...

We only offer insurance in the state of California. Lic #0E51783

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