Get a Quote for Insurance

Affincon is here to help your with all your insurance needs. Please complete the form below and an agent will contact you shortly to consult with your about the best medicare solution for your needs.

Senior Care / Medicare Solutions Quote Form

Fields marked by an asterisk (*) are required fields.
 

Senior Care Insurance Coverage Requested


Type of Insurance:*
Daily Benefit Desired*  per day (For LTC only)
Mode of Premium*
 

Insured Information


Name*     Gender  
Date of Birth*
Address   Unit/Apt/Lot #  
City   State     Zip  
County
Email*
Home Phone   Work    Cell 
 

Required Medical Information


Smoker*
Please describe any medical conditions:
List any Medications
being taken:

The protection of your privacy is important to us. Rest assured that the personal information you provide us with will not be disclosed to other parties and will be used solely for the purpose of bringing you the best service possible.
Life insurance

""I can recommend Ron Dutton, without reservation, as an expert in helping to find the best and most affordable insurance coverage available. Mr. Dutton helped me untangle the enormous mountain of information I received as I became eligible for Medicare. He listened carefully to my needs and concerns and used his exceptional expertise to advise me concerning my new coverage needs. Mr. Dutton is not only an expert in his field he is a man who can be trusted.""
Janet Love
Lawrenceville, GA