Necessary Information

• Company name
• Address
• Type of industry
• Phone number
• Email address
• Number of employees eligible for coverage
• Number of employees obtaining coverage
• Total number of employees (including part-time)
• The federal tax id and department of labor numbers are required, but not necessary to obtain a preliminary quote.

We will ask for your census information

• You may use the on-line form or you may upload a PDF or Excel file.