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Please complete the following information and submit this form. Once Best Companies Group receives this form, you will be sent a confirmation email with detailed information about the survey process.


Company Name (as it should appear in print):
*
Legal Name of the Company (if different than listed above.):
Federal Employer Identification Number (FEIN):
Mailing Address:
(No home addresses)
*
City:
*
County: *
State:
Zip Code: *
Company Website URL: *
Industry: *
 
Retail Agents/Brokers — are companies that work directly with policyholders to place commercial lines insurance business and provide related services.

Wholesale Brokers/Managing General Agents — are companies that derive more than 50% of their premium volume from wholesale brokerage or companies that derive more than 50% of their premium volume from acting as a managing general agent, underwriting manager or Lloyd’s of London coverholder (authority to bind risks for Lloyd’s syndicates, similar to an MGA).
Reinsurance Brokers — are companies that work directly with ceding companies to place reinsurance and provide related services.

Property/Casualty Insurers — are companies that provide commercial lines property/casualty insurance on an admitted or non-admitted basis.
Group Life/Health Insurers — are companies that provide group health insurance, managed care companies and companies that provide group life insurance.
Claims Manager — are companies that handle commercial insurance claims for self-insured clients on a direct, unbundled basis; or companies that offer case management services directly to members of employer-sponsored group plans.
Benefits Brokers & Consultants — are companies that engage in group health plan consulting, design, administration or procurement.
Reinsurers — are companies that assume all or a portion of the risk and premium taken by an insurer. Reinsurers effectively insure insurance companies.
Association, Service Organization — are organizations aligned with the commercial insurance industry, including employee benefits. Organizations in this category are either supported by the companies identified in other categories, or activities are closely aligned with commercial insurance.

Primary Contact (This person will be the main contact for questions throughout the entire process and the recipient of all communications via email, phone, website and letters, employee surveys for distribution, feedback reports, etc.)
Salutation: *
First Name: *
Last Name: *
Title: *
Mailing Address:
(No home addresses)
*
City: *
State: *
Zip Code: *
Direct Dial Phone Number:
(No home or cell phones please)
*
Fax Number: *
Email Address: *

Secondary Contact (This person will be the contact for questions if the primary contact is unavailable.)
Salutation:
Name:
Title:
Direct Dial Phone Number:
(No home or cell phones please)
Email Address:

CEO, President, Manager, Etc. (Highest ranking position in the nominated workplace.)
Salutation:
Name:
Title:
Mailing Address:
(No home addresses)
City:
State:
Zip Code:
Direct Dial Phone Number:
(No home or cell phones please)
Email Address:

IT Contact (This person will be the contact for any technical systems questions regarding online surveys - for all employer questionnaires and online surveys for employees - regarding filtering, spam content, white-listing, etc.)
Salutation: *
Name: *
Direct Dial Phone Number:
(No home or cell phones please)
*
Email Address:
*

Marketing/PR Contact (This person will handle any marketing and/or public relations questions for your company.)
Salutation: *
Name: *
Title: *
Direct Dial Phone Number:
(No home or cell phones please)
*
Email Address:
*

Additional Company Information:
Total number of employees in the United States (full- and part-time permanent employees only).
Total US Employees: *
Full-time Employees: *
Part-time Employees: *
* Participation fee: The fees are based on the size of the company and the selected survey method.
Number of Employees
# Employees Surveyed
Online Fee
Paper Fee(1)
 
25 - 99
All
FREE
$375
100 - 199
All
FREE
$505
200 - 499
Up to 250(2)
FREE
$585
500 - 2499
350(2)
FREE
$685
2500 +
400(2)
FREE
$840
(1) Fees are non-refundable.
(2) Employees are randomly selected. Best Companies Group offers the option to survey more employees than the random sample calculated in the above chart, and/or include additional employees in the survey process who work in locations outside of the program area. Please contact Best Companies Group for details and pricing.
* Survey Type: Please select what kind of survey you would like to receive.
Free Online Survey (Electronic):
Paper Survey (Hard Copy):
   
Additional Survey Options:
 
Does your company need alternate
language surveys?*
Yes
No
* We offer employee surveys in a variety of languages. Additional languages are available at $205 per survey translation. If you need alternate language surveys, please select the above button and you will receive additional information. If you decide to pay online below, selecting yes to this section will automatically add the $205 to your bill.
 
If Other
Is your company interested in customizing the job role and department category demographics on the employee survey?
Yes, I am interested in receiving more information.
There is a fee of $795 to customize. What is this?
 

Special Offer
Purchase your Employee Feedback Report Now and Save.* This report details the results of your company’s specific survey results to each of the 78 survey questions. The report also includes benchmarking as well as the employee comments transcribed exactly as submitted by employees. Similar reports can cost thousands of dollars if initiated independently.

Number of
Employees
Pre-survey Pricing (discount)*
Regular Pricing
Savings
 
25 - 99
$820
$910
Save $90
100 - 199
$920
$1,020
Save $100
200 - 499
$970
$1,080
Save $110
500-2499
$1,040
$1,155
Save $115
2500 +
$1,080
$1,200
Save $120
No, thank you

*After June 1, 2018, the reports go back to regular pricing.

 
Questionnaire:
How did you hear about the program?
If Other
   
Did you participate last year?
If yes, Name of the company if it is
different than above:
   

Please be aware that as part of the “Best” program, a certain threshold of employee survey responses must be received in order for the analysts to consider the survey data valid. If a company does not meet this threshold, their full consideration for the “Best” list may be jeopardized, even resulting in elimination. In the rare case a company’s response rate is extremely low, a statistically valid Employee Feedback Report will not be presented (if purchased).
Name of person completing this registration form:
Your Name:
*
Your Title:
*
Your Email Address:
*
Are you authorized to enter your
company into this process:
*
Commitment:
* I understand that by clicking this submit button, our company is entered into the "Best Places to Work in Insurance" program. I am committing to meet all deadlines and complete both portions of the assessment process. If at any point we choose to withdraw from the process, we will notify a representative of Best Companies Group at 1-877-455-2159 immediately. Companies withdrawing after June 1, 2018, will incur a $250 withdrawal fee in addition to the total fees incurred for any special requests (customization orders, language translations, paper survey processing, etc.).
IMPORTANT: If any of the contact information changes at any point in the process, please notify Katie Henson at KHenson@BestCompaniesGroup.com immediately.
Checkout Options:
Option 1:
My organization is eligible for the free online survey. We do not need language translations, paper surveys nor do we wish to order the Employee Feedback Report at this time.

Submit my Free Registration

Option 2:
My organization needs paper surveys, language translations or wishes to order the Employee Feedback Report.
* Payment:
Pay online now
Invoice me

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