Please complete the information below. All fields required.
Your Name
 
Title
E-Mail Address
Company Name
Company Address
Please use numbers only (ie. 5555555555)
Company Phone
Company Fax
Proposal Due Date

Please mark the appropriate box(es) for your proposal request.
     Premium Only Plan (POP)
     Flexible Spending Accounts (FSAs)
     Cafeteria Plan with Menu Style Benefits
     COBRA Administration
     Transit and Parking Benefits
     Retirement (401(k), Profit Sharing, Money Purchase)
     Self-Funded Benefit Plans
     Premium Billing & Eligibility Tracking
     Other:

Eligible Employees
Part-Time Employees
Plan Year
 
Industry  
New Plan     or     Existing Plan (Takeover from another TPA)
Current Administrator

 
Thank you for your interest in Trust Administrators, Inc.