Canter Insurance Agency: Insurance Services

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Information Request For
Intercollegiate & Other Sports Related Insurance Plans
and
Domestic & International Student Health Care Plans

To obtain further information about Insurance and other Benefit Plans available to schools for their students/athletes, provide the following information and click the "Submit" button at the bottom of this form.

The fields displayed using bold text are required to submit.

First Name:
Last Name:
Street:
City:
State/Province:
Zip Code:
Telephone w/Area Code:
Fax w/Area Code:
E-mail Address:
School Name:

Please contact me via: (Check the method you prefer)
Telephone
E-mail
If you want to be contacted by telephone, select the best time to contact you:

Please select the plan(s) for which you would like to receive information. (Check all that apply.)

Intercollegiate and Other Sports Related Insurance Plans
Request for Information

Intercollegiate Sports Accident Insurance
Catastrophic Athletics Injury Insurance
Staff Accident Insurance
Summer Sports Camps/Clinics/Leagues – Accident, Medical Liability Insurance
Intramural/Recreational Sports Programs
Club Sports Accident Insurance

Domestic & International Student Health Care Plans
Request for Information

Student Health Insurance Plans for International Students
Student Health Insurance Plans for Domestic Students
Student Dental Plans
Student Vision Plans
Mandatory Student Accident Plans

Thank you for your request and input!

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Canter Insurance Agency
22147 Carinloch Street
Calabasas, California 91302
(818) 226-9255 (800) 726-2422
License #0787997
E-mail Us

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