Professional Benefit Administators
Home Disability Dental Benefits Vision Benefits Life Benefits LegalShield AutoHealth Contact us

Enrollment Forms






Agent Forms




Cancellation Forms





Customer Support


You can mail or fax forms to:

Professional Benefit Administrators
31 S Center St
Winder, GA
30680-3457

Phone: (770) 963-3939
Toll-free: (800) 578-2082
Fax: (770) 963-6126
Toll-free Fax: (888) 264-6975

Contact PBA, Inc.

  
First Name:  *
Last Name:  *
Address:  *
Address (cont.):  
City:  *
State:  *
Zip:  *
Phone:
Federal/Non-Federal:  *

If Federal Employee please list Agency and Union.
Agency:
Union:
Work Phone:
Fax:
E-mail:
URL:

Please select insurance information you would like to have sent to you.

Dental Insurance
Life Insurance
Disability Insurance - Subject to availability.
Vision Insurance

We will send information on the different types of insurance you have
selected above that is available in your area.

* required fields

 
Copyright © 2024 Professional Benefit Administrators. All rights reserved.
Terms and Conditions