Short Term Team Quote Page 2 - Good Neighbor Insurance

Thank you for starting the process!

We need a bit more information in order to provide you with a customized group travel insurance plan that best fits your needs.

Please use the form to the right to provide us with everything needed to find you the best possible policy.

"*" indicates required fields

First Name

Last Name

Email*

Phone

Would you like to schedule a video call?

Yes

Are you part of a team? (Which?)

Organization name

Where is your team going?

Have we helped you/your group before?

Yes

Don’t know

Name of the Point of Contact/Team Leader?

Total value of trip?

The non-refundable, prepaid costs of trip

Require Trip Cancellation?*

Desired length of coverage?

Travel date-Start?

Travel date-Return?

Deductible Preference

Need rider for extreme sports?

Yes

About your team/group:

The number of participants (0, 3, … , qty) on your team, based on their age.

Age of participants: 0-17

Age of participants: 18-29

Age of participants: 30-39

Age of participants: 40-49

Age of participants: 50-59

Age of participants: 60-69

Age of participants: 70-79

Age of participants: 80-above

Comments?

We’re open 8:00-16:00 (Arizona Time) Monday-Friday. On work days we provide quotes within 24 hours, and usually much sooner than that. If your request is submitted over the weekend, we will get a quote to you before the end of the work day on Monday.

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