Current Primary Contact Details

Title: CEO
Name: Tony Ali
Phone Number: +19139012105

Email: [email protected]

Do you need to make changes to the above Primary Contact details? *

Employer Contacts (1 of 4)

Primary Contact (non-broker)

Title *

Name *

Phone Number *

Email *

Next: Secondary Contact / 3. Invoicing Contact / 4. Broker Contact

Current Secondary Contact Details

Title:
Name: Tony Ali
Phone Number:

Email:

Secondary Contact Changes *

Employer Contacts (2 of 4)

Secondary Contact (non-broker)

Secondary Contact Title *

Secondary Contact Name *

Secondary Contact Phone Number *

Secondary Contact Email *

Next: Invoicing Contact / 4. Broker Contact

Current Invoicing Contact Details

Title: CEO
Name: Tony Ali
Phone Number: +19139012105

Email: [email protected]

Do you need to make changes to the above Invoicing Contact details? *

Employer Contacts (3 of 4)

Invoice Contact (non-broker)

Invoicing Contact Title *

Invoicing Contact Name *

Invoicing Contact Phone Number *

Invoicing Contact Email *

Next: Reporting Contact

Current Reporting Contact Details

Title: CEO
Name: Tony Ali
Phone Number: +19139012105

Email: [email protected]

ReportingContactChanges

Employer Contacts (4 of 5)

Reporting Contact

Reporting Contact Title

Reporting Contact Name

Reporting Contact Phone Number

Reporting Contact Email

Next: Broker Contact

Current Broker Contact Details

Employer Contacts (5 of 5)

Broker Contact

Title:CEO
Name:
Phone Number: +19139012105

Email: [email protected]

Broker Contact Changes *

Note: If your broker contact hasn't changed, select NO above click "Submit" to continue to the next section. If your broker contact has updated, please select Yes above then complete the fields below.

Brokers Company Name

Broker Full Name

Broker Phone

Broker Email

NUESYNERGY WORLD HEADQUARTERS

4601 College Blvd (Suite 280)

Leawood, KS 66211

SALES INQUIRES

1-855-890-7239 (option 4)

[email protected]

CUSTOMER SERVICE

1-855-890-7239 (option 2)

[email protected]

COBRA & DIRECT BILL SUPPORT

1-855-890-7239 (option 2)

[email protected]

EMPLOYER SUPPORT

1-855-890-7239 (option 3)

[email protected]