Employer Details

The following information is to be completed by an authorized representative of .

Current Employer Information

*Note: Owners/partners and employed spouses, children, grandchildren, and partners of owners/partners of S-Corp, LLC, and Partnerships are not eligible. A Sole Proprietor is not eligible.

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NUESYNERGY WORLD HEADQUARTERS

4601 College Blvd (Suite 280)

Leawood, KS 66211

SALES INQUIRIES

1-855-890-7239 (option 4)

[email protected]

CUSTOMER SERVICE

1-855-890-7239 (option 2)

[email protected]

COBRA SUPPORT (BROKER/EMPLOYER)

1-855-890-7239 (option 4)

[email protected]

EMPLOYER SUPPORT

1-855-890-7239 (option 3)

[email protected]