Request For Information

If you are interested in pet insurance for your dog or cat and wish to make a request to receive more information about MAX Pet Insurance Programs, just fill in your details below.

Let us answer your questions now

PTZ Insurance Agency, Ltd.

P.O. Box 2150 , Buffalo, NY 14240-2150

Call us toll free:

1-866-432-6299

Fax: 1-866-369-PETS (7387)

Call Centre Hours
(Eastern Time)
9:00am to 12:00am (Mon-Fri)
10:00am to 8:00pm (Sat)

Administration Hours
(Eastern Time)
8:00am to 8:00pm (Mon-Fri)

First Name:*
Last Name:*

Address:*
City:*
Zip Code:*
Day Phone:
Evening Phone:
E-mail:*

	In order to provide you with the proper Quote, we request the following:
Type of Pet :*	Dog Cat Both
	Information About Your DOG
Name:
Breed:	;
Age:
	Information About Your CAT
Name:
Breed:
Age:

Do You Currently Have Pet Insurance?	Yes No
Insurance Company

How did you first hear about the Max Pet Insurance Programs?	E-mailer Other
Please Specify:

Questions / Comments:

	NOTE: fields marked with an * are mandatory.

Plan for the future - the accidents and illnesses that happen to your dog or cat cannot be anticipated and are always unexpected. Although many people avoid thinking about their pet getting sick until it actually happens – the time to think about it is NOW.