| | | Disability Information Form | | | The first step in obtaining disability insurance coverage is to complete the AMTDA Disability Insurance Information Form. Complete the form on line and return it to Affinity Brokers & Consultants. | | | Note: the form is a printable ADOBE pdf. that should be
completed on-line, printed and returned by FAX or mail. | | | |
| Affinity Brokers & Consultants
4510 Cox Road, Suite 111
Glen Allen, VA 23060 | | | | FAX (804) 273-9989 |
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