If you currently have a group health plan or employee benefits package, and would like to become a client and enjoy the benefits of being a SBBG family member, please fill in name of company in the box below, print the page, transfer it to your letterhead, sign and fax to 708-361-8555.

BROKER OF RECORD

  exclusively recognizes Small Business Benefits Group (SBBG, Inc.) as the Broker of Record for its Employee Health and Welfare Programs. SBBG, Inc. will act solely on the behalf of the this organization to procure the most cost effective benefit programs.

 Date: ____________________________

 By: ____________________________

 Title: ____________________________

Small Business Benefits Group