Individual Forms

To get specific plan information and access your enrollment form, click on the Health Care Provider you have chosen. Fill out the application and email it to Susanne.Hanes@swickfinancial.com, or sign and fax it to us at 909.398.0016.

For an individual quote,
call Susanne Hanes at
(909) 621-2996
Coverage Options & ApplicationCoverage Options & Application

Swick Financial & Insurance Services  |  414 Yale Avenue, Suite A  |  Claremont, CA 91711  |  909.621.2996  |  fax 909.398.0016

Jess M. Swick – CA Insurance Agent License #0412056

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