Frett/Barrington Limited

Frett/Barrington Limited
21001 Watertown Rd.
Suite 301
Waukesha, WI 53186
(262) 780-5400

The Employee
Benefit Specialists

Employer Group Quote Form

Please complete the pre-quote questionnaire below to help us identify your company's needs. A Frett/Barrington associate will contact you within one business day.

Frett/Barrington Limited is the Employee Benefits Specialist. We can help your company implement a full range of benefit plans, including health, dental, life/AD&D, voluntary life/AD&D, disability, voluntary disability, flexible spending accounts, health reimbursement accounts, wellness programs, and P.O.P plans. We also offer consulting-only services.

Required fields are in bold and marked with a *.

First Name*	Last Name*
E-Mail Address*
Phone Number* - -	Fax Number - -
Company Name*
Company Street Address Line 1	Company Street Address Line 2
Company City	Company State	Company ZIP Code
Which Group Insurance Lines Are You Interested In? (Check All That Apply) Dental Flexible Spending Accounts Life/AD&D Long Term Disability Medical Premium Only Plan Short Term Disability Vision
Requested Effective Date (MM/DD/YYYY) / /
Current Insurer(s) (Enter "None" If Not Applicable)
Total Number of Employees
Industry Description
SIC Code (if Not Known, Enter "None")
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