Serving the Inland Empire
of Southern California

Life - Health - Dental - Vision
Short term Disability
Long term Disability
and Supplemental Benefits
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Get a quote tailored to your needs.
Just fill out the form below, and we will contact you within a few days.

Name
Phone
Fax
Email
Date of birth
Address
City
State
Zip
Insurance type:
Medical   Dental   Vision
Insurance style:
PPO (back end coverage, with a deductible, and lower premiums)
HMO (up front coverage, with no deductible, and higher premiums)
Insurance for:
Single
Subscriber Spouse
Subscriber Child
Subscriber children
Family
Do you want maternity coverage?   Yes   No
Family members to be included in your quote.
Enter one person per line as: Name, DOB, Relationship
If you want life insurance please answer these questions
Policy amount
Your height
Your weight
McGinty Insurance Designs

909 862-2699   Fax: 909 862-2432

CA Insurance License: 0764737
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