Moran Benefits - Online Quote form

  • Date Format: MM slash DD slash YYYY
  • You can enter employee data in the chart below by clicking the 'Add Employee' button and following the prompts. OPTIONAL: If you would rather send us employee data via excel spreadsheet click to download our template file. After completion, use the 'Select File' button below to upload your completed census template.
  • Employee NameDOBGenderEnroll/WaiveZipSpouse DOB# of Children EnrollingChildren #1 DOBChildren #2 DOBChildren #3 DOBChildren #4 DOB 
  • Drop files here or
    Accepted file types: xlsx, csv.
    See directions and template above.