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Welcome to J. Deutsch Associates

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Request a Quote

Here at J. Deutsch Associates, we try to make the whole process quick and easy for our clientele. To begin your quote request, please fill out the form below and then hit submit. We will review the information and get back to you shortly.

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BOTH THE BELOW FORM AND THE FORMS FOR DOWNLOAD PERTAIN TO NY DBL INSURANCE
This form can also be downloaded:
  

Policy Holder Information:
Policy Holder Name:*
Line of Business:*
Address 1:*
Address 2:
City:*
State:*
Zip Code:*
Contact Information:
First Name:*
Middle Name:
Last Name:*
Company:*
Address 1:*
Address 2:
City:*
State:*
Zip Code:*
Daytime Telephone:* - -
Fax: - -
Email:*
Insurance Information:
Number of Employees:*
Number of Males:
Number of Females:
Current Carrier:*
Current Rate:*
Plan Design:*
If the current plan is enriched please describe plan features:
Claims Experience:

If there are more than 50 employees please provide premium and claims experience if available:

Date Premium Claims
1
2
3
4
  

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