Integrated Benefits
and Insurance Services, Inc.

2400 22nd Street, Suite 100
Sacramento, CA 95818
(916) 457-0444  (800) 660-9006
E-Mail: info@integratedbenefits.biz
Web: www.integratedbenefits.biz

California License # 0629367

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BLUE CROSS OF CA
BLUE SHIELD OF CA
HEALTH NET
TRAVEL MEDICAL

Request a quote for GROUP MEDICAL

Integrated Benefits & Insurance Services Inc. represents most major carriers for
Employee Benefits in the State of California. Please complete the attached questionnaire
so that we may shop your company’s benefits.  We are available for a free benefits review
at 800-660-9006.

Please select which type(s) of Insurance you would like a quote on
Medical Dental Vision Life Disability
 

 

Contact Information
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Contact Name:
Phone:
Current Provider:
Renewal Date:
% of Employee
Coverage Paid:
% of Dependent
Coverage Paid:
   

   

Employee Information
Last Name (Optional) Date of Birth     Sex Children Occupation Salary
 

 

 

 

 

 

© 2006 Integrated Benefits and Insurance Services, Inc.