Step 1 of 2

Your contact info

We’ll use this to reach you with the completed quote.

Client Name * Please enter the client name.

Agent Name * Please enter your name.

ZIP Code * Please enter your ZIP code.

Work Email * Please enter a valid email address.

Phone * Please enter a valid phone number.

Client details

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

Is this a current client? *

Yes No

Home State *

Please select a state.

ZIP Code * Please enter a ZIP code.

Client Tax ID Number

Number of Full-Time Employees * Required.

Master Plan State *

Please select a state.

Open Market Quotes Needed? *

Yes No

Group Size *

5–25 25–100 100+

Ancillary Products

Proposed Effective Date * Please select a date.

Additional Notes

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.

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.