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Note: this is an informal request for information
and not an application for services.

BCBS Information Request
*Contact Name:
*Restaurant Name:
*Address:
*City:
*State:     *Zipcode:
*Phone:
Fax:
*Email:

*County:
  # of full-time employees
  # of employees to insure
Current Health Coverage:
Best time to contact:
Comments:

 
   

© 2003 by Michigan Restaurant Association
225 West Washtenaw - Lansing, MI 48933

General Contact Numbers:
Phone: 800-968-9668 or 517-482-5244 - Fax: 517-482-7663

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