Client Contact Information Form

Please use the secure form below. All transmissions to our database are secured to the highest standards.

Please Note: Navigating away from this page before completing and submitting the form will cause all previously entered data to be lost. This is a security feature designed to protect our clients against identity theft and internet fraud.

WARNING: Do NOT use the "Back" button on your browser or navigate away from this page without submitting the completed form. Failing to submit the form before navigating away will result in loss of data and you will need to begin the form again. This security feature is for your protection.

Schedule a Free Consultation

Testimonials

I was introduced to Ted earlier this year by a mutual acquaintance and have had the opportunity to work with him since. Ted takes a comprehensive approach to working with his clients and does not leave any stone unturned. The team that he has assembl… Read More
– Adam Eisenberg, Owner, Midwest Insurance Group

View All Testimonials

closeClose