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About Your Agency
Agency Name
*
Website URL
*
First Name
*
Last Name
*
Phone number
*
Email
*
Job title
*
Annual Employee Benefit Revenue
*
Under $1.5M
$1.5-$5M
$5M-$10M
Over $10M
Number of employees
*
Please Select
1-5
5-25
25-50
50-100
100-500
500-1000
1000+
Vertical Market Specialization
*
(Please List Industries)
Number of Clients with Less Than 50 People
*
0
1-10
10-25
25-50
50+
Number of Clients with 50 to 500 People
*
0
1-10
10-25
25-50
50+
Number of Clients with 500+ People
*
0
1-10
10-25
25-50
50+
Administrative Systems/Partnerships
*
(Select what you currently have or use - you can select more than one)
CRM System
Commission Tracking System
Document Builder/Marketing Info
Data Analytics
Health Questionnaire
Benefit Administration
Compliance System - 1094/1095
Other
Message
*
Any strengths in the marketplace? What is your agency struggling with most? Anything you want our team to know about your Agency/Benefits Team?
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