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SMALL BUSINESS
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What are your goals? (choose all that apply)
(Required)
Improve employee satisfaction & retention
Attract new talent
Add or improve health benefits
Explore new benefit solutions
Reduce costs for the business
Reduce costs for employees
Grow/scale the business
When would you like your new benefits to start?
(Required)
Emergency
Next few weeks
Within 1 month
Within 3 months
Within 6 months
Start of next calendar year
What type of coverage are you needing?
(Required)
Small Business
Self-Employed
Other
Business Info
Business Name
(Required)
Year Founded
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Briefly describe your product/services
(Required)
State
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-select-
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
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District of Columbia
Florida
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Maine
Maryland
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Michigan
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Ohio
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South Dakota
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Texas
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Virginia
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West Virginia
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Wyoming
Total number of full-time employees aged 18-64
(Required)
-select-
1
2-10
10-25
25-50
50-100
100+
Do any employees live in a different state?
(Required)
Yes
No
Are you currently providing any type of employee benefits?
(Required)
Yes
No
Do you currently have any sort of health insurance?
(Required)
Yes
No
Contact Info
Your Name
(Required)
Title / Position
(Required)
Cell
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Email
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How did you hear about Nectar Benefits?
(Required)
-select one-
Client Referral
Google Search
Networking Event
Educational Event
Convention / Trade Show
Other
Who referred you to Nectar Benefits?
(Required)
Do you have any specific questions or comments? (optional)
Phone
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SMALL BUSINESS
SELF-EMPLOYED
FAMILY & INDIVIDUAL
MORE SERVICES
LEGAL SUPPORT
IDENTITY PROTECTION
PET INSURANCE
RESOURCES
PLAN OVERVIEW
TRAVELING
TESTIMONIALS
PRICING
CASE STUDIES
TERMS GLOSSARY
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