Legendserv.com
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Legend Services where Legends are made. Give us a try and make your mark as a Legend.
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Group Health Census Form - Page 1
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Contact Person:
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Job Title :
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Company Name:
Company Address:
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City:
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Zip:
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Company Phone Number:
Alt. Phone Number :
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Type of Business:
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SIC Code
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Current Plan Underwriter:
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Coverage Types:
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Health
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Long Term Care
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Coverage Start Date:
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1 January
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1 March
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1 July
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1 September
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Number of Employees:
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Dean and Lynn Clark
21818 Treemont Hollow Ct., Richmond, TX 77469-7250
Office 281-239-6966 Toll Free 1-888-239-6966 Fax 281-239-6954
dean@legendserv.com
lynn@legendserv.com