We created the online proposal tool to allow you to request proposals for your
clients quickly and efficiently. The information provided from this
questionnaire will allow us to create a proposal that is tailored towards your
client’s specific administrative needs. Upon submission of your request, a
detailed confirmation e-mail will be sent to the e-mail address provided in the
form. A business development team member will be in contact with you upon
receipt of this information. We appreciate the opportunity!
* All fields are required unless labled as Optional.
Brokers Info
Employer Info
Proposed Services ( Select all that apply )
COBRA Administration Info