New Case Opportunity
Discovery Checklist - Broker

Use this form to submit a new case opportunity to Forester Benefits Management.

Need help?

Contact:

Email: sales@foresterbenefits.com
Phone: (866) 229-6048

* ALL FIELDS REQUIRED. ALL FIELDS MUST BE ANSWERED OR THE FORM WILL NOT SUBMIT.

EMPLOYER GROUP INFORMATION
ADDITIONAL NOTES
Please email all in-force plan designs, rates, census, and broker commission requests to sales@foresterbenefits.com.
ALL FIELDS ARE REQUIRED. IF YOUR FORM DOES NOT SUBMIT, YOU MAY HAVE MISSED AN ANSWER ABOVE. CHECK THE FORM AND RESUBMIT.

Broker Information

Employer Group Info

EMPLOYER GROUP INFORMATION

Payroll Info

Ben Admin

Enrollment Method

Employee Benefits Offered

Forester Services

ADDITIONAL NOTES
Please email all in-force plan designs, rates, census, and broker commission requests to sales@foresterbenefits.com.
ALL FIELDS ARE REQUIRED. IF YOUR FORM DOES NOT SUBMIT, YOU MAY HAVE MISSED AN ANSWER ABOVE. CHECK THE FORM AND RESUBMIT.