Stanton Insurance Agency


Protect Your Family & Ensure Their Future! Just answer a few questions below which will take less than a minute of your time. We Try To Keep Things Simple! When completed click submit and we will call you back with a quote today!


First Name*	A first name is required.
Last Name*	A last name is required.
Date of Birth
Amount of Coverage Desired
Do You Smoke?	No Yes
What is your email address?*	An email address is required.
Telephone Number Where You Can Be Reached Today!* Special Note: If you submit this form or call our office after business hours we will call you back the very next business day!	A phone number is required.

230 Second Avenue, Suite 105 • Waltham, MA 02451 • Tel 781-893-3200 • Toll Free 888-893-3201 • Fax: 781-893-7516

Protect Your Family & Ensure Their Future!