The Following is a list of Forms Needed for Quoting your Business. Please Click on the Link to open each form. You can Either Fax them us securely at 1.888.315.4205 or attach and email them to This e-mail address is being protected from spambots. You need JavaScript enabled to view it

Important ! Please fill out each form as completely as possible. If you have questions please do not hesitate to call us at 505.819.5502 Ext 0 or Toll Free 1.888.315.4205

RFP (Required) Basic information about your Business

UMAF (Required, One for each Employee) Only have Employee fill in Spouse and Children Information if they are potentially requesting Health Insurance Coverage for them. Any Questions that are answered yes must have a description of the Treatment or Issue listed at the Bottom. The information on these forms is protected by Federal Law and will not be shared except with specific underwriters for the specific purposes of quoting the group.)

UMAF (Spanish Version)

Census (No Current insurance) (Required) Please fill in completely and email to This e-mail address is being protected from spambots. You need JavaScript enabled to view it

Census (Currently have Insurance) (Required) Please fill in completely and email to This e-mail address is being protected from spambots. You need JavaScript enabled to view it