Serving Oklahoma’s
Legal and Accounting
Professionals since 1955
 
 

 

  
 

Home Office
PO Box 60809
Oklahoma City, OK 73146
4201 N. Barnes
Oklahoma City, OK 73112

Call Today:
405-521-1600 or
800-530-4863
E-mail: beale@bealepro.com

  
     
 

Quick Quote

  
 
First name
Last name
Sex Male Female
Firm
Which organization are you (or your employer) a member of? Oklahoma Bar Association
Oklahoma Society of Certified Public Accountants

Are you a member or an employee of a member?

Member
Employee 		Other
E-mail
FAX
Work Phone
Date of birth
Street address
Address (cont.)
City
State
Zip
Have you used tobacco in the past 12 months? Yes No

What type of information are you interested in? Check all that apply.

 

 
Health Insurance
Spouse DOB
# Dependent Children
Business Office Package Workers Compensation
Term Life Personal Umbrella (OBA members only)
Disability Income Accountant's Professional Liability
Business Overhead Expenses Long Term Care
Group Health / Life / Dental (an employer census will be needed) Employment Practices Liability (OSCPA Only)
Dental Other
May an agency representative contact you? Yes No
How did you find out about Beale and the OBA/OSCPA insurance plans?

Please send a premium estimate via

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This is not a secure page. If you prefer, you may print out this form, fill in the blanks, and fax it to (405) 521-1610, or mail it to our office at the address below:

Beale Professional Services
PO Box 60809
Oklahoma City, OK 73146

  
 
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