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Intelligent System Solutions for Group and Individual Insurance
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Information Form
Please fill out the following form so we can understand your business needs. An * indicates a required field.
General Information  
Company Address
Company City
Company State
Your Title
Your Phone
Your Email
Type of Business  
Insurer Commercial Company
TPA Software Vendor
Reinsurer Other
Present Products  
Group LTD
Life Medical
Individual STD
DI Dental
Network Environment  
Mainframe Client/Server
Mostly Manual Dumb Terminal
PC 486 - Pentium PC Other
Software Interest  
Medical Claim Management Administrative Systems
Disability Claim Management Life Claim Management
Dental Claim Management
System Status  
We are going to build in-house.
We want to buy a system and purchase code.
We want to buy a complete system and support package.
We are surveying product availability.
Installation Needs  
6 - 12 Months
12 - 24 Months
24 - 36 Months
Just Exploring
Size of Claim Block  
500 - 1000 Claims
1000 - 3000 Claims
3000 - 5000 Claims
5000 or more Claims
Please send additional information.
Please call me to discuss.
We would like a product demo.

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