Step 1 of 2

Your contact info

We’ll use this to follow up with the completed quote.

Your Name * Please enter your name.

Your Phone * Please enter a valid phone number.

Your Email * Please enter a valid email address.

Client information

Provide details about the client you’re submitting for a quote.

Is this a current client? *

Yes No

Client Company Name * Please enter the client company name.

Primary Contact Name * Required.

Primary Contact Phone * Required.

Primary Contact Email * Please enter a valid email.

Address Line 1

City

Zip Code

State

Client Tax ID Number

Number of Employees * Required.

Proposed Effective Date

Additional Notes & Products to Quote

Supporting Documents (up to 6 files)

Drag & drop files here

RAPT Census (w/ Dep Info), GHQ Form, existing plan details, renewal pricing, premium invoice

This form and any information transmitted with it are confidential and intended solely for the use of the individual or entity to whom they are addressed. Applied Business Solutions Inc. is committed to protecting the privacy, accuracy and reliability of any personal information you choose to provide and to safeguarding such information from loss, misuse, unauthorized access, disclosure and alteration.

Quote Request Received!

We’ll review your submission and provide a tailored health insurance quote within 2–3 business days. Our team will be in touch shortly.

Schedule a Call

Frequently Asked Questions

A PEO (Professional Employer Organization) offers full HR solutions for small to mid-sized businesses, providing cost-effective insurance, streamlined HR tasks, and compliance, enabling focus on core operations with robust HR support.

Yes! With a Master Health Plan smaller companies can be underwritten with much larger organizations, resulting in lower rates and more affordable coverage for employees. Offering a Master Health Plan makes healthcare insurance more affordable and improves cash flow for your clients.

Submitting client information is simple and secure. Complete the form above and upload any supporting documents. For more information, visit our Privacy Policy.

Absolutely. We prioritize the security and confidentiality of all data shared with us. Our platform uses advanced encryption techniques and complies with industry-standard data protection regulations to ensure your client’s information remains private and secure.

Once you’ve submitted all the necessary client information, you can typically expect a tailored health insurance quote within 2–3 business days. Our team works diligently to ensure that you receive accurate and competitive quotes in a timely manner.

Yes! Our platform is designed to handle multiple quote requests simultaneously. Simply follow the submission process for each client and we’ll provide individualized quotes based on their specific needs.

We’re here to help! If you have any questions or encounter any issues during the submission process, please reach out to our dedicated support team at info@hrdelivered.com.