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St 800 Superior Ave. 21 Floor Cleveland OH 44114 www. AmTrustDB. com T 800. 535. 2711 F 800. 584. 9370 NY DBL Quick Quote Request 50 Employees NY Disability Benefits Law Insurance DateDate Quote Needed byNumber of pages including this sheet To dbunderwriting amtrustgroup.com From Fax Phone 646. 458. 3561 Phone Email RISK NAMEProposed Effective Date Nature of BusinessFEIN Current CarrierEffective Date Coverage please mark with X StatutoryEnriched specify Total NY EmployeesMalesFemalesAdd l...
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