Linda Mackey Insurance
The Agency With Vision          678 870 9983
Census

Please put together this information and fax it (678 870 9984) or e mail it (lmackey@lindamackeyins.com) to us. We can get you rates for your small business from this information. Don't forget your contact information.  If you have this information on a spread sheet, we can easily work from that.

NEVER CANCEL ANY INSURANCE YOU HAVE IN PLACE UNTIL YOU ARE SURE NEW COVERAGE IS IN EFFECT!!

Your Company's Name

Nature of Your Business

Company Address



Your Name

Contact Phone Number



Name

Gender

Age

Spouse
Age

Number
of
Children

Home
Zip
Code

Salary
(for
Disability)

Types of
Insurance
Desired




 * Download form here  (Adobe PDF file)



Please let us know if you have group coverage now, If everyone is on workers compensation

Any known pre existing conditions

What types of insurance you want to see.
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