-->

GROUP QUOTE :: EMPLOYEE CENSUS

 
Company: Contact:
Address: City:
State: Zip Code:
Phone: Fax:
Type of Business: SIC Code:
Number of FTP Employees:
 
  Name Gender Age Date of Hire Type of
Coverage
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
 
Please answer the following questions so that we can make an accurate comparison:
 
1. Who is your current insurance company?
2. What are your current premiums?
3. What deductible would you like quotes for? ($250 -$5000)
4. What effective date would you like?
5. Are you interested in Dental or Vision coverage?
6. What type of plan are you interested in? (PPO, HSA, etc)
Sagamore Benefits Group
8395 Keystone Crossing, #110
Indianapolis, IN 46240
800-627-7475
email:  sagamore@sagamorebenefits.com