Please click on the appropriate form listed below. Once completed, hit SUBMIT and it will be sent directly to us.

Individual / Business Overhead
This form is for all Individual Proposals and all Business Overhead Expense cases.

Buy Sell Proposal Request
This form is for Buy / Sell monthly, down payment, or lump sum benefit amount proposals.

Multi-Life Offer Request Form
Use this form for cases with three or more lives and for which you would like to propose an executive carve out program, a retirement completion program, a group supplement program, or other type of multi-life disability income benefit program. This form will allow us to negotiate/request Guarantee Issue or Simplified offers from the insurance carriers. Additionally, a census in an Excel Spreadsheet is required including:

		Company Name and Address
		Employee Name (First, Last)
		Sex
		DOB
		Resident State
		Occupation
		Salary
		Bonus/ Commission

Click here for our pre-formatted excel spread sheet census form.

Once completed, please e-mail census to info@drgdi.com.

Please feel free to contact us at 800-945-9719 to discuss the case, underwriting concerns, program design, and competition and carrier selection.

General turn around time is within 24 hours for most Individual / Business Overhead and Buy-Sell requests.

Please allow additional time for Multi-Life requests.