Benefit Services Logo - Group and Individual Insurance, HSA, HRA. We help cut your insurance premiums.
Phone: (248) 553-9040
info@benefitservicesgroup.com
 
Home > Group Quotes
Home
About Us
Ask The Benefit Brain!
Services
Client Access
Quotes
Newsletter
Knowlage Library
Appointment
Free Seminars
Subscribe to our newsletter
We discuss pertinent subjects relating to financial and insurance related topics that could benefit you, your employee's and your company.
H.R. University
Free Seminars RSVP Today!

 
Group Quotes

Individual Quotes ] Census Update ] [ Group Quotes ]

Group Quote

* Required

 How would you prefer to be contacted?

Telephone E-Mail Fax

  Please enter your contact information:

Name *
Company *
Address *
Address 2
City *
State *
Zip *
E-mail *
Phone *
FAX
Current Group Health Carrier:

  
Which areas would you like a group quote for?

Medical    Dental    Long Term Disability   Short Term Disability

Life Insurance    401(k)    Vision    Cafeteria Plan  Other:

If you checked "Other", or if your situation is in any way not covered by the choices on this form, please describe your needs in the text box below and be sure to fill out enough contact information above so that we may get in touch with you.

Comments:

  Date of Birth* Sex* Zip* Smoker(Y/N)* Coverage* # of Children*
 Employee 1
Employee 2
Employee 3
Employee 4
Employee 5
Employee 6
Employee 7
Employee 8
Employee 9
Employee 10
Employee 11
Employee 12
Employee 13
Employee 14
Employee 15
Employee 16
Employee 17
Employee 18
Employee 19
Employee 20

Subscribe to our e-mail newsletter!

  Privacy Statement

Copyright 2008, Benefit Services Group, Inc.   Home | About Us | Ask The Benefit Brain! | Services | Client Access | Quotes | Newsletter | Knowlage Library | Appointment | Free Seminars