REQUEST A QUOTE

Thank you for your interest in Diversified Administration, Inc. and the services that we offer.In order to provide you with the best possible quote, please answer the questions below:

First Name:
Last Name:
Email:
Company:
I am an employer
I am an agent or broker

I am interested in a quote on the following products or services:
*Discounts may be available for multiple services

Section 125 Premium Only Plan
Section 125 Flexible Benefits Plan
HRA Plan
COBRA Administration
Welfare Benefits 5500 Form Preparation
Welfare Benefit Wrap Document
Continuing Education Classes
The group has
employees
This is a new plan
 Yes
No
We are replacing our service provider for an existing plan Yes
No
For HRA, please tell us something about the plan design that you have in mind
Anything else that will help us prepare the most accurate quote for you
   

 
Diversified Administration, Inc. © 2012
6161 Washington Street, Hollywood, FL 33023 • Phone: (954) 983-9970 • Fax: (954) 983-9695
claims@div125.com
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