Your unique benefits needs will dictate what information we need from you in order to provide you with a fast and accurate quote.

NOTE: We recommend first saving the files below onto your computer, and then editing them (versus opening them in your browser and editing them).

Determine Which Category Best Describes You

You'd Like a Quote From Multiple Carriers

1. Please complete a Company Information Form 2. Please complete a Census Form 3. Once finished, please send us your completed forms as outlined below!

You'd Like a Consultation on the Best Benefits Package for You

1. Please complete a Company Information Form 2. Please complete a Census Form 3. Please gather a copy of your most recent bill from your current carrier 4. Please gather a copy of your current plan design 5. Once finished, please send us your completed forms as outlined below!

Your Group has 25 People or Less, and You'd Like an Accurate Quote

1. Please complete a Company Information Form 2. Please complete a Census Form 3. Please gather a copy of your most recent bill from your current carrier 4. Please gather a copy of your current plan design 5. Please have each employee complete a Health Statement NOTE: To ensure HIPAA-Compliance, have employee provide this to employer in a sealed envelope, or simply have employee fax direct to us at (480) 892-0927 6. Once finished, please send us your completed forms as outlined below!

Send Us Your Completed Documents

Please e-mail all completed doucments to services@gljinsurance.com. If you have any questions, feel free to get in touch with us!