THANK YOU FOR REQUESTING THE CENSUS FORM
Please click on one of the buttons below to download the Census form in .doc or .pdf format.
It is important that ALL EMPLOYEES (Full and Part-time) be listed on the census form, not just the ones that are requesting group insurance. This doesn’t mean that someone who has insurance through another source, e.g., Medicare, will be required to sign up for this plan. But the insurance companies do want to know the total percentage participating.
DON’T FORGET TO DOWNLOAD AND FILL IN THE GROUP QUOTE FORM
Please click on one of the buttons below to download the Group Quote form in .doc or .pdf format.
Once we receive this information we will approach several group carriers to get quotes based on the specific needs of your organization. We will then create an actionable analysis comparing benefits and options to help you save the most money on your future premiums.
Don’t forget to bookmark this page so you can get back to it without re-entering your information
When complete, the forms can be submitted via email to Pei Hsieh (as an attachment), or can be mailed or faxed to:
Good Neighbor Insurance
ATTN: Group Department
690 E. Warner Road #117
Gilbert, AZ 85296