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ADVANTAGECARE FORMS

Please click on any of the forms below to download.  All Brunswick dealers may request a quote, but only GOLD and PLATINUM dealers may enroll in the program.

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Quote Request Form (PDF)

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Participation Agreement


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Employee Enrollment Form (PDF)

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Employee Waiver Form(PDF)

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Spanish Employee Enrollment & Waiver Form - Medical


Independent Retailers Benefit Trust | Toll Free Phone: (866) 641-8836 | Fax: (866) 524-1412
Mailing Address:  1300 Jefferson Street , Suite 206  | Des Plaines, IL  60016

Copyright Independent Retailers Benefit Trust 2007 - 2009.  All rights reserved.