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If you are interested in selling the Surecard Benefits Package please complete the following form. We will use this information to establish your agent account. Thank you for your interest in Surecard Benefits.

Sure Card Benefits Plan
1754 Woodruff Road, Suite 226
Greenville, SC 29607
Corporate Office: 864-970-4156
Toll Free: 888-277-4456

Please fill in all the required fields*.
A representative from our firm will contact you asap.

Agent Name:*
Agent Company Name:
Agent Phone:*
Agent Email:*
Agent Soc. Sec. Number:*
Agent Cell Phone:*
Agent Address:*
Agent State:*
Agent Zip:*
Recruited By:*
Group Enrollment Number:
Recruited as manager?:*
Number of Reps:*
Comments: