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For more information about how the Christian Brothers Employee Benefit Trust can serve your organization, please provide the following information. So that we can better serve you, please fill in your contact information completely and accurately. We will never share this information with anyone outside Christian Brothers Services.

Your Name:

Your Organization:

Number of Employees:

Address:

City:

State:

Zip Code:

Telephone Number:

Fax Number:

Email Address:

How would you prefer we contact you?

Which benefits interest you?

Health Care Plans	Insurance Programs
Medical/Prescription Drug Coverage Dental Coverage Vision Coverage	Term Life/Death and Dismemberment Long-term Disability Group Long-term Care
Other Programs Prescription Drug Coalition Flexible Spending Account

What questions do you have about our services?

How did you hear about us?

Or if you would like to contact one of our benefit consultants directly, please contact any of the following:

John Airola
Managing Director
1205 Windham Parkway
Romeoville , IL 60446.1694
Phone: 800.807.0100 Ext. 2450
Fax: 630.226.2169
John_Airola@cbservices.org

Jim Adam
Senior Benefit Consultant (Western US)
Phone 800.807.0100 Ext. 3011
Fax 630.679.5118
Jim_Adam@cbservices.org

Susanne Anderson
Senior Benefit Consultant (Central US)
Phone 800.807.0100 Ext. 3043
Fax 630.679.5159
Susanne_Anderson@cbservices.org

Kristine Walker
Senior Benefit Consultant (Eastern US)
Phone 800.807.0100 Ext. 3044
Fax: 630.679.5142
Kristine_Walker@cbservices.org

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