Legend Services - Where you can find the best insurance rates and service on the net! Try it, you'll love it! Legendserv.com     A Developed and Experienced "Legend" of Services

Mission: Legend Services where Legends are made. Give us a try and make your mark as a Legend.
Group Health Census Form - Page 1
* indicates required
 
 
*Contact Person:
 
*Email Address:
 
*Company Name:
 
*Company Address:
 
*City:
State:
   *County:    *Zip:    
 
*Company Phone Number:
 
Alt. Phone Number :
 
*Type of Business:
 
 
*Coverage Types Desired:
(check all that apply)
Health
Life
Dental
Vision
Disability
Accident
 
*Coverage Start Date:
 
*Number of Employees:
(Minimum 2. Employee = 30 plus work hours average per week in the business and receives a paycheck with taxes taken out.)
 
*ATNE:
Average total number of employees/month last year
 
Additional Comments:
 


 
Caution: Please check that the above
information is correct before proceeding.

 

 

Aetna Insurance Blue Cross Blue Shield Insurance Cigna Insurance Humana Insurance VBA UnitedhealthOne Insurance Unitedhealthcare Insurance International Travel Health Insurance Prudential Genworth Baylor Scott & White Memorial Hermann Allegian Choice Aliera Oscar IHC Petersen
Dean and Lynn Clark
21818 Treemont Hollow Ct., Richmond, TX 77469-7250
Mobile Web Site: m.legendserv.com
Office 281-239-6966   Texting 281-239-6966   Toll Free 1-888-239-6966   Fax 281-239-6954
dean@legendserv.com   lynn@legendserv.com