1) Company Details

Who we’re quoting for

Company Name * Contact Person * Phone * Email * Website Type of Business Number of Years in Operation

Address City Province / Territory

2) Employee Snapshot (optional)

Add a quick employee census (helps accuracy)

#	Name	Age / DOB	Class	Gender	Coverage	Title	Salary

Tip: If you don’t have details handy, leave this blank—we can still start with a preliminary range.

3) Benefits You’re Interested In

Tap to select (toggle on/off)

4) Plan Details & Preferences

Not sure? Leave blank—we’ll recommend options.

Health Coinsurance % Drug Coverage % Drug Cap (annual)Dental Coinsurance % Major Dental % Dental DeductibleRecall (months) Orthodontics (details) Waiting Period for New Hires

Budget (monthly, optional) Anything else we should know?

5) Follow-Up Preferences

How should we connect?

Preferred Follow-Up Method Best Time to Reach You

By submitting, you agree we may contact you to discuss your quote. Your information is kept confidential and never sold.

Renewal should never be reactive.

If your renewal is approaching within the next 4–6 months, now is the ideal time to begin benchmarking.

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Madhu Shukla, CFP®, EPC | Green Mountain Financial Services Inc.

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1) Company Details

Company Name *

Please enter the company name.

Contact Person *

Please enter the contact person’s name.

Phone *

Please enter a phone number.

Email *

Please enter a valid email address.

Website

Type of Business

Number of Years in Operation

Address

City

Province / Territory

Postal Code

2) Employee Census (optional)

#	NAME	AGE / DOB	CLASS	GENDER	COVERAGE	TITLE	SALARY

Tip: If you don’t have details handy, leave this blank — we can still start with preliminary ranges.

3) Benefits You’re Interested In

Tap to select (toggle on/off). Multiple selections allowed.

4) Plan Details & Preferences (optional)

Health Coinsurance %

Drug Coverage %

Drug Cap (annual)

Dental Coinsurance %

Major Dental %

Dental Deductible

Recall (months)

Orthodontics (details)

Waiting Period for New Hires

Budget (monthly, optional)

Anything else we should know?

5) Follow-Up Preferences

Preferred Follow-Up Method

Best Time to Reach You

I agree to be contacted by Green Mountain Financial Services Inc. about my quote request. (Required)

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By submitting, you agree we may contact you to discuss your quote. Your information is kept confidential and never sold.

Group Benefits

Free Group Benefits Quote

1) Company Details

2) Employee Snapshot (optional)

3) Benefits You’re Interested In

4) Plan Details & Preferences

5) Follow-Up Preferences

Renewal should never be reactive.

Stay informed with practical financial planning insights for Canadians

Partners & Carriers We Work With

Free Group Benefits Quote

1) Company Details

2) Employee Census (optional)

3) Benefits You’re Interested In

4) Plan Details & Preferences (optional)

5) Follow-Up Preferences

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