Worksite Benefit Alliance, LLC.

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If you are interested in becoming a Preferred Enrollment Counselor with Worksite Benefit Alliance, please complete the following profile or download the Enroller Profile Sheet and return via fax.

We look forward to adding your name to our TEAM.

Name:

Company Name:

Street Address:

City:

State:

Zip:

Phone:

Fax:

Cell:

Email Address:

How many years have you been enrolling?

Have you done call center enrollments?

Are you willing to travel?

If so, can you work on extended projects?

In what states do you hold a current license?

With what companies are you currently appointed?

What insurance companies have you enrolled for?

What products have you enrolled?

Do you carry Errors and Omissions coverage?

What are your coverage limits?

Have you enrolled with an enrollment firm before?

If so, who and do you still work with them?

Have you used laptop or internet enrollment systems?

If so, what systems?

Do you have your own laptop and signature pad?

What is your requirement for payment?

Frequency (i.e. Monthly, Semi-monthly)?

What notice do you require in advance of enrollment?

Are you Bilingual?