Please complete and submit the following quote to Comprehensive Benefit Services, Inc.
Today's date
Company Name:
Address 1:
Address 2:
City:
State:
Zip:
Phone:
Fax:
Contact Person:
E-mail:
Nature of Business:
SIC Code:
Tax ID#:
# of Employees:
Are there any other physical office locations? No Yes
If so, please provide the address of each location:
Type of quote you would like:
Life/AD & D
Medical
Dental
Short Term Disability
Long Term Disability
Retirement Plan
Amount of employer contribution for benefits:
Life/AD & D
$ or %
Medical
$ or %
Dental
$ or %
STD
$ or %
LTD
$ or %
Agent Requesting Quote:
Lee V. Bethel, CLU, ChFC, REBC, RHU
Comprehensive Benefit Services, Inc.
5568 General Washington Drive, Suite A-217
Alexandria, VA 22312
Phone: (703) 813-5551
Fax: (703) 813-6170
E-mail: lee.bethel@lpl.com
Any other questions or comments:
NOTE: You will not be able to change your information once you submit this form. Please review for accuracy before hitting the Go To Next Form button.
Lee V. Bethel is securities licensed in the following states: AL, AZ, CO, DC, DE, FL, GA, IL, IN, MD, NY, OH, OK, PA, SC, TX, and VA. Lee V. Bethel is insurance licensed in the following states: VA, MD, DC, PA, IL, CT, OH, and OK. For Securities Information, click here. Securities offered through Linsco/Private Ledger, Member FINRA/SIPC.
