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Friday, September 10, 2010


Warner Pacific Small Group Quote Request Forms
At Warner Pacific you have the choice of generating your own small group quote online and receiving it within minutes via e-mail or you may download one of the attached Quote Request Forms, complete the necessary information, fax it over to us at 1-800-609-0111 and we will run the quote for you. Once complete, you can request a personalized bound proposal delivered to your doorstep within 24 hours at no cost to you.

Click an item below to view quote request forms.
Electronic Form Electronic Quote Request Form            Adobe PDF Printable Quote Request Form

Adobe PDF Colorado Small Group Quote Request Form

Adobe PDF Colorado Small Group Fact Find

Warner Pacific Individual Quote Request Forms
Adobe PDF California Individual Quote Request Form

Adobe PDF Colorado Individual Quote Request Form

Adobe PDF Colorado Individual Underwriting Prescreen Form
Adobe PDF Michigan Individual Quote Request Form

Adobe PDF Michigan Individual Underwriting Prescreen Form
Warner Pacific Large Group Quote Request Form
  1. Download and save the Large Group RFQ Excel file.
  2. Enter the information required in the three tabs.
  3. Save the Excel file.
  4. Click here to email the Excel file to our large group specialists.
Should you have any questions or need more assistance, please contact our Large Group Specialists,
at WPLargeGroup@WarnerPacific.com or 1-800-801-2300:

Javier Salguero, ext 152
Kristin Fortney, ext 446
Cathy Scrivner, ext 474
Jennifer Glick, ext 134
Celia Cohn, ext 445

  1. Download and save the Large Group RFQ Excel file.
  2. Enter the information required in the three tabs.
  3. Save the Excel file.
  4. Click here to email the Excel file to our large group specialists.
Should you have any questions or need more assistance, please contact our Large Group Specialists,
at WPLargeGroup@WarnerPacific.com or 1-800-801-2300:

Cathy Scrivner, ext 474
MS Excel
MS Excel