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Business Contact

Contact Name: *
Business Name: *
Business Description: *
Business Address: *
City: *
State: *
Zipcode: *
Business Phone: *
Business Fax:
County: *
Current number of full-time employees eligible for group employee benefits: *
- One Person
- Two Person
- Family (3+)
List Chamber of Commerce and other business/industry associations to which your company belongs:
Current group benefits carriers, if any:
Health: *
Current group insurance agent’s name: *
Group Employee Benefit Needs:

How else can we Assist you?

* Indicates Required Fields

© 2019 Grotenhuis. ALL RIGHTS RESERVED
588 3 Mile Road NW Suite 101, P.O. Box 140167, Grand Rapids, MI 49514-0167
Phone: (800) 748-0368 or (616) 949-7950 Fax: (877) 329-2844 or (616) 949-2502

Grotenhuis is an Authorized Independent Managing Agent for Blue Cross® Blue Shield® of Michigan and Blue Care Network. Blue Cross Blue Shield of Michigan and Blue Care Network are non-profit corporations and independent licensees of the Blue Cross and Blue Shield Association.