Question Title

* 1. Your Company's Name

Question Title

* 2. Your Company's Street address

Question Title

* 3. In what state or U.S. territory is your company currently headquartered?

Question Title

* 4. Is your company U.S.A. based?  If not, what country are you located in?

Question Title

* 5. Your contact name / title.

Question Title

* 6. What is your work email address?

Question Title

* 7. What is your phone number?

Question Title

* 8. What is your website address?

Question Title

* 9. If your company operates under any other names (d/b/a), please indicate the other name(s) here.

Question Title

* 10. Has your company done work for Lifetime Healthcare Co. / Excellus or any of its subsidiaries in the past? Please explain.

Question Title

* 11. Have you recently met with anyone at Lifetime Healthcare Co. / Excellus, if so whom and for what reason?

Question Title

* 12. Is your organization currently doing business with any other BlueCross/BlueShield Plans, if so please explain.

Question Title

* 13. If your company has any certifications you would like to share, please attach them here.

Question Title

* 14. Describe the primary types of products/services your company offers.

Question Title

* 15. Briefly explain why your company is uniquely qualified. What differentiates you from your competitors?

Question Title

* 16. Please feel free to attach one file with relevant case studies and/or appropriate promotional materials.

T