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Florida Direct Insurance Agency writes health insurance in several states. Florida Direct writes group, individual policies, mini meds, major medical

for companies such as Aetna, Blue Cross and Blue Shield, Fortis, Golden Rule, United Healthcare, and many others. Florida Direct is already conforming

their health programs for their customers to meet the new government standards (Obamacare). Although the Gov't program is not taking full effect until 2014,

there are rules and guidelines you should follow now to reduce your costs. Please complete the form below and we will contact you to make an appointment

you at your convenience to educate you as to the upcoming changes in healthcare.

Health Quote Form

Company Name :

D/B/A :

Mailing Address

Address :

City : State: Zip:

Physical Address

Address :

City : State: Zip:

Contact Name:

Phone #() - Check Here if you would like a call rather than completing the form online

Alternate Phone #() -

Fax #: () -

Email:

Best Time to Contact and Where (Normal Business Hours)

Federal Employer Identification Number: -

Type of Entity:

Description of Operations :

Present Health Carrier: