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Should you need any assistance in submitting the AC-3 and company profile form or have any questions, you may contact a member of our support staff at 216-606-1100. Please note that submission of the AC-3 does not guarantee group enrollment and/or premium discount. There are two ways to fill out the required forms. You may download the printable PDF form, fill it out, and fax it back to us at 216-606-1111. Or you may fill out the online form for faster processing. Please choose an option below:
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