Agent Sign Up Form

If You Are An Insurance Professional:

  • who markets primarily to large group employers with 50 or more employees,
  • interested in saving your customers money through alternative funding mechanisms such as partial self funded plans, TPA (Third Party Administrative), Life and Disability and Medicare Supplement services,
  • who is a recognized leader in the broker community,
  • who is a part of an established organization that successfully distributes quality products to producers,
  • with a substantial knowledge of your territory and one who provides vital feedback about your competitive position in the market place,
  • with the ability to sell an organization that is committed to service as well as providing a competitive product,

Then Central Benefits Wants You On Our Team!
Please fill in the following information and a sales executive will contact you shortly.

Name:
Title:
Agency:
Email Address:
Mailing Address:
City:
State:    Zip:
Phone: Fax:

Comments:

Thank you for your interest in Central Benefits! <% end if %>

 
 


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