BeneNet Application
You may complete this form on-line and submit it via this web site. You will need to fill out the census or email one where indicated.
You may also print a PDF version of this form and return it by fax or mail with your Employee Census. All questions must be answered to proceed to page two.
Fax to:NVTC BeneNetfax: 703.777.2668
Mail to:NVTC BeneNet20 South King StreetLeesburg, VA. 20175
E-mail to: NVTC BeneNet
Employee Benefit Coverage OptionsPlease select the coverage you wish quoted. You will only see further information and questions relating to the options you have selected. You may wish to select two options to compare the cost difference.
Have a question?Click here to send it.
Apply Online.Click here to receive a proposal for insurance coverage.
Program Managing Partner:AH&T Insurance703-777-2341800-648-4807
We're truly different.Contact us today.