Located At: 10 Mountainview Rd. South, Unit #7 Georgetown, Ont. L7G 4J9 Phone: 1 (905) 702-7700 Fax: 1 (905) 702-7030   Mladenka Alilovic Owner/Directing Manager Email: goldenstarinsurance@bellnet.ca Direct: (905) 302-1256   Lily Jurkas Manager/Insurance Broker Email: lilyjurkas@sympatico.ca Direct: (289) 259-0870 Located in Waterdown   Please fill out the following form for a quote: Name: Address: Phone Number: ### ###-#### Email Address: Type of Service: Critical Illness Disability Group Benefits Health Insurance Life Insurance Mortgage Insurance Please answer the following additional questions specific to the type of service you wish a quote on. Name of employer: Employer Address: Employer Phone: ### ###-#### Employer Email: Product interested in: <select one> Critical Illness Dental Disability Medical Please answer the following additional questions specific to the type of service you wish a quote on. Age: Gender: Female Male Smoking Status: Non-smoker Smoker Amount ($ value): How many people to be insured? Copyright 2006, Goldenstar Insurance Brokers Inc. All rights reserved. Web site designed and maintained by Ricon Consulting Inc.