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Group Benefit Broker Getting Started Form 

Please give us the following information about your agency
Name Agency 
Address Address (cont'd)  
City St   Zip 
E-mail 

How did you hear about the T&R Group? (select 1 or more)      

  Phone   Fax 

Please Check all that Apply:

I have downloaded,  completed and faxed back a Broker Agreement.  Please send contracts so I can start writing business!

 I still have questions.  Please have someone call me!  (or call us at 1-800-742-2722!)


 

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