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Dear Prospective Client,

If you wish to be contacted regarding offering benefits to your employees, please answer a few brief questions by clicking the 'continue' button, below. I will personally follow up with you as soon as possible.

Sincerely,

Jane E. Plumberg, Owner & President
Accelerate Insurance
913.745.4006
 
 
 
Please indicate benefits you currently offer:
 
Group Medical
 
Group Life
 
Group Disability
 
Group Dental/Vision
 
Voluntary employee-paid benefits
 
Other (please indicate)
 

 
 
 
What products would you be interested in learning more about?
 
Group Medical
 
Group Disability
 
Group Term Life
 
Group Dental/Vision
 
Employee-elected Benefits
 
Cancer/Specified Disease
 
24-Hour Accident Insurance
 
Other (please indicate)
 

 
 
 
Requested meeting time/date/location:
   
 
 
 
Name
   
 
 
 
Phone
   
 
 
 
Best time to call
   
 
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