Request a Quote

For your free insurance quote, download the appropriate form below. Click on the image to open the document in your web browser. Or, right click on the image and select “Save Target As…” to save the form to your computer. Fill out the information and email the form to or print the completed form and fax it to (715) 598-4411.
After receiving your form, we will contact you within 2 business days with your insurance quote. If you have any problems filling out the form, please call (715) 598-4412.

For individuals or families, download this form


For small or large groups, download this form

Valley Benefits Group Health Census .jpg