Qualification Form
Do you currently offer group insurance? Yes   No
 
Have you offered group insurance in the past 12 months? Yes   No
 
Do you have more than 2 employees and less than 50 employees? Yes   No
 
Does your business reside within one of the providing counties (Brazos, Burleson, Grimes, Leon, Madison, Robertson or Washington county)? Yes   No
 
 
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