Become a Partner

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Contact Information

First Name

Last Name

Company Name

Company street address

Unit/suite

City

State

Zip code

Email Address

Phone Number

Staff & structure

How many employees do you have total?

# of Sales Associates

# of Account Managers

# of Underwriters

About the company

How many opportunities can you generate annually?

Do you represent any competing programs (ie Benefits Captives)?

How much of your business is in the 20-500 market?

Fully-Insured

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Level-funded

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Self-funded

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Working with Benecon

Please list any other information for us in the space below.

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