Maine Consumer Health Insurance

:: E-ZQuote Form

	Fast & Easy to use
	No-hassle way to find your best options
	Your information is kept safe & secure
	Save money and time
	No commitments or credit checks, ever

“Thank you MECH – I got the right plan for me and my business, just as you promised I would.”
-- Meredith V., Portland

“Thanks to MECH, we found a health plan that fits our budget AND our ‘unconventional’ lifestyle!”
-- Stan and Barbara C., Falmouth

“I was so worried about finding a plan I could afford that would cover both me and my daughter. What a relief. Thank you (MECH).”
-- Ester J., Kennebunk

PRIVACY POLICY

MECH does not share your confidential personal information with anyone except MECH member agents and companies.

First Name:

Last Name:

Street Address:

City:

State:

ZIP:

Email:

Phone:

- Ext.

Date of Birth:

/ /

Weight:

Height:

Gender:

Male Female

Tobacco Use:

Yes No

Include Spouse in Quote:

Yes No

Date of birth:

/ /

Weight:

Height:

Gender:

Male Female

Tobacco Use:

Yes No

Include Children in Quote:

Yes No

Number of Children:

Ages of Children:

(example: 2, 8, 10)

Health Insurance Details:

Do you currently have health insurance:

Yes No

If Yes, who is your current provider?

If "other", who is your provider?

Click here to submit your E-ZQuote Form: