The Benchmark Planning Group is excited to start working with you, please fill out the form for our team to start working on solutions for your company. Please enable JavaScript in your browser to complete this form. - Step 1 of 4Company Name *Company Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeIndustryLines of coverage to be quotedNextWhat is your renewal date *Employer contribution *How long with current carrier if less than 5 years, provide carrier history by yearHRA/GAP Plans Funding if anyNextPerceived strength of current planObjectives, challenges/concerns with current coverage *Wish list of benefit package (if you can have anything what would be on the list)NextCopy of Invoice, upload most recent carrier invoices * Click or drag a file to this area to upload. Fill Out & Upload Census Form (download above) * Click or drag a file to this area to upload. Upload Plan Summaries * Click or drag a file to this area to upload. Upload Most recent renewal * Click or drag a file to this area to upload. Submit Census Form Download: CLICK HERE TO DOWNLOAD CENSUS FORM
