• Group Health Proposal Request Form - Please Complete Part A, B, C and then click submit

  • PART A - COMPANY INFORMATION AND CURRENT BENEFITS

  •  -  - Pick a Date  :
  • Part B - EMPLOYEE CENSUS - you can fill this section out or e-mail requested information to info@integrated-insurance.com (sending information in excel format is preferred), or click file up load and upload your census

  • PART C - DESIRED COVERAGE - here you need to describe what type of coverage you are looking for

  • If you have questions please feel free to call us at 888.823.1342 or e-mail info@integrated-insurance.com

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