:::Dalton Insurance Agency - Lake Toxaway, North Carolina



		ASSESS YOUR DEDUCTIBLE : Raising it to $500 can result in a lower insurance premium. Just be sure you can afford to pay the deductible if you are in an accident.

Health Insurance

Health Insurance comes in all shapes and sizes. From individual and family coverages to employer-sponsored plans, the choices can be confusing and complex. Based on your needs, I will compare over eighteen different companies to find the coverage you deserve. Other important insurance coverages are available, also. These include Long-Term Care (Nursing Home), Medicare Supplement, Disability, Cancer, Accident/Sickness, and Dental coverage's.

Name		Address
City		State
Phone		Zip Code
E Mail		Fax
Height	Feet Inches	Weight
Date Of Birth		Describe Any Medical Conditions
Check if you use tobacco		Check below any inclusions you would like with your health insurance policy
Dr. Office co-pay Prescription Drug Card Maternity
Would you be interested in additional insurance policies? Please check your interests below.
Dental Disability Accident/Sickness Medicare Supplement Nursing Home Coverage Cancer
You may enter any comments here. Please include information on spouse or children, their date of birth, jobs and medical history if they are to be covered under this policy.
How would you like for us to contact you? Phone Fax E mail Postal Mail		If you request a phone call, when is the best time to call?
Thank you for taking the time to submit this information. To send this information simply click the Send button to the right. We will contact you within 48 hours with your quote.