Welcome to
CorsittoAgency.com!
Located in downtown Seaford,
we are a family owned agency
proudly serving our clients
and our community for
over 50 years! We offer
complete insurance services
for all of your personal and
commercial needs.
Why Corsitto? "It's a Name You Can Trust!"
Corsitto Insurance is an Independent Agency, Dedicated to Serving YOU!
We represent several leading insurance companies rather than any single provider. Therefore, we have the ability to continually monitor the marketplace and offer you the best possible rates.
Our goal is to provide you the highest level of customer service and dedicate our resources to meet your needs and earn your trust. Our success is based on your continued satisfaction.
UNDERWRITING INFORMATION
Insured Name:
Birthdate:
Insured Height:
Insured Weight:
Spouse's Name:
Spouse's Birthdate:
Spouse's Height:
Spouse's Weight:
(M/F):
Include Spouse?:
Yes No
Include Children?:
Yes No
List children's names, (first & last), their relationship to you, and birthdates: (up to 6 children)
Be as specific as you can on the underwriting questions below so we may find the most competitive product for you!
Does any family member living
in the household use or has used any tobacco products? (if yes give
dates, and details in remarks section).
Yes
No
Describe usage (cigar, cigarettes, etc, and how long.)
Any Pre-existing Health Conditions?
(If yes, descibe in detail, and to which of the insured persons they apply.)
Any Covered Persons Currently Taking Medication of Any Kind?
(If yes, descibe in detail, and to which of the insured persons they apply.)
COVERAGE INFORMATION
Are You Looking for Coverage for more than 6 months?
What Deductible Are You Interested In? ($250, $500, $1000, $2000 etc.):
Any special coverages needed? (Maternity, H.M.O., P.P.O., etc.)
If you're looking to reduce premium
cost, and want information on the NEW HSA (Health Savings Plans),
check the HSA box here and we'll include information.
Please Include HSA Information
Tell Us What You Want MOST in your Health Plan, or list any other Remarks here:
Send my quotation via:
E-Mail Fax Regular Mail
Call me by Phone!
Thank you for filling out this form
COMPLETELY!
We value your input as PRIVATE information. Every step has been
taken to insure your privacy, security, and our intent is to release quote information only
to you. We will not give your data to ANY other person or group for sales, marketing,
or ANY other purposes. By checking the box below you agree to allow our agency to release this information via the method you have chosen, and to
release us from any liability should this information be accidentally viewed by others.
Our intention is to maintain your complete privacy.
Yes, I Agree.
Please Send Me My Health Insurance Quote NOW!
Click Button Below When Done
Please Click Only Once . . . May take up to 30 seconds!
Corsitto Insurance Agency
3900 Merrick Road | Seaford, NY 11783
Phone: 516-783-0400 | Fax: 516-783-0431 Contact Us
Corsitto Agency.com is an agency with highly qualified professionals committed to finding the best coverages and prices for
your New York Homeowners, Auto and Business insurance. We give instant New York Insurance quotes, and fast online homeowners, auto,
and business insurance quotes for all New York residents. Some of the keywords which can be used to find our services include:
New York Homeowners insurance, New York waterfront home insurance, NY house insurance, New York auto insurance, NY car insurance
NY business insurance, business owners insurance, New York commercial insurance, New York insurance rates, NY discount insurance prices,
and other New York insurance Products. Please contact us for a free, no obligation New York Insurance Quote today!
