Laird Financial Services Group Inc.

Request A Quote

Request A Quote

Please take a minute and fill out the form below. Laird Financial will then contact you and provide you with an individualized quote based upon the coverage you require. This service is offered free of charge without any obligation.

Privacy Policy of Laird Financial Services Group Inc.

The information you give, either online or by email or facsimile, is collected and maintained with the utmost privacy. Your contact information will only be used to contact you regarding your insurance or investment needs. Your personal information will not be sold or leased to a third party, nor will it be used for advertising purposes. Any personal information you enter on this website will be used only to assist in giving you the information you need. If you would like to opt-out at any time, please contact info@lairdfinancial.ca

Laird Financial is licensed to provide quotes to residents of British Columbia.

Personal Information

Enter your personal information. Please provide as much detail about any health conditions that you might have. *Denotes a required field.

* Name

* Date of Birth:

* Gender  Male Female

* Smoking status in the past 12 months  Non-Smoking Smoking

List any specific health issues:

Occupational Information

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Occupation:

Employer:

Total income in the last 12 months:

Do you own your own business?  Yes No

Are you Incorporated?  Yes No

Contact Information

Enter as much of your contact information as you can, and please advise us how you would like to be contacted. *Denotes a required field.

* Daytime Phone: Evening Phone:

* Email:

Mailing Address:

Preferred Method of Contact:

Requested Information

Request information on the following products:

 Personal & Corporate Life Insurance  Retirement Planning Disability Insurance  RRSPs, RRIFs, Annuities, RESPs Critical Illness Insurance  Long Term Care Insurance Individual Health & Dental  Health Trusts Group Employee Benefits  Mortgages Other Information

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