Advantage Benefits Group, Inc.

Name of Business:
Address:

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State:		Zip/Postal Code:
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Description of Business:
Total Number of Employees:
Please quote the following lines of coverage:
	Group Life
	Group Short Term Disability
	Group Long Term Disability
	Group Medical
	Group Dental
	Other

78 Pleasant Street | Suite 300 | Worcester, MA 01609
Toll Free (800) 426-2413 | Vanessa@AdvantageBenefits.com | Bill@AdvantageBenefits.com