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Complete the information below and we’ll prepare Group Health Insurance comparisons for your small business.
In some cases, we have been able to save employers as much as 24% on their group health premium. We’ll provide this information to you at no cost and no obligation.

If you already have a census in another format that’s ready to send, email that to us at: [email protected]

If you prefer, you may click here to download this form and send it to us via email, fax or postal mail.

Group Health Insurance

Employee Census Form

Employee 1


We do not sell, share or trade your personal information with any person or company. You will never receive any annoying or unsolicited calls from us.
We deal with frustrations of robocalls and unsolicited calls on our own personal phone numbers which is why we are very possessive of the information you share with us.
The only unsolicited communication you will receive from us will be a mailed Christmas card or an occasional holiday card.
We respect you and your privacy.

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