Information Request
If you are a corporate or union looking for more information on having
Spencer Insurance Services, Inc custom design a voluntary supplemental
benefits package for your employees or union members, please fill out all
the information below and we will respond to you as quickly as possible.
Name 

Title    Number of Employees/Members 

Company/Union Name 

Address 

City  State  Zip 

Work Phone   Home Phone 

E-mail Address 

Best Way To Contact Me 

Best Time To Contact Me 

I am interested in getting more information about the following benefit service: (you may choose more than one)
Disability Income Plan Critical Care Plan
Home & Auto Insurance Group Legal Plans
Other (please state your interests in the comments section below)
If you have any questions or comments, please state them below and we will respond to your needs as quickly as possible.
Comments:

Spencer Insurance Services, Inc.
444 West Ocean Boulevard, Suite 800
Long Beach, California 90802
Phone:  (562) 624-2876
Fax:  (562) 624-2877
E-mail:  skoslov@sis-inc.com