Skip to main content
#
Daystar Services, LLC.
service & claims
payments
resources
contact
our facebook page
site map
Group Health Quote
Group Health Insurance Quote

Contact Information
Group Name:
Telephone:
Group Contact:
Fax:
Group Address:
City, State & Zip:
E-Mail Address:
Current Health Carrier: Effective Date:
# of employess: Cobra Employees
How long in business:
Worker's Compensation?: Employees in waiting period:
Group Census
(If More Than 10 Employees, please call us to receive
a large group census form.)
Employee #
Birth Date (mm/dd/yy)
Gender
Zip Code
Select Coverage
# 1
# 2
# 3
# 4
# 5
# 6
# 7
# 8
# 9
# 10
Additional Comments
Please give any additional comments or questions

No coverage of any kind is bound or implied by submitting information via this online form

  • We will only use information provided to assist in obtaining appropriate insurance quotes and coverage.
  • We will not distribute information to other parties other than for insurance underwriting purposes.
  • By submitting this form, you agree to release us from any liability should this information be accidentally viewed by others.


Site Mailing List  Sign Guest Book  View Guest Book 
Let us make the grass greener on your side!
Daystar Services
3900 N. Causeway Blvd.
Suite 1200
Metairie, LA 70002

Phone:  (504) 273-0056
  Fax:  (888) 316-5821
 
Email Us

Hours of Operation:

Mon-Fri: 9:00-5:00
 


 

© Daystar Services, 2010-2012    webmail login


Unauthorized duplication or publication of any materials from this site is expressly prohibited.
Powered By: Insurance Web Designs Websites For Insurance Agents