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**Referrals please*** Plaza Research Houston is looking for brokers/agents who are actively involved in selling healthcare insurance to medium to large companies. The agents/brokers will receive $350 for participating in a 1-hour telephone interview. We will be conducting interviews throughout this week (July 13th – July 17th ).

Please answer the questions below. If you look like a match, we will contact you by telephone.

**Due to the large response to our surveys, we are only able to contact those that look like a match. Please continue to answer future studies, as you may be a match to those.

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* 1. Please provide us with the following information. We will be contacting you by telephone if you seem like a match.

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* 2. Alternate Contact number

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* 3. What is your Employment Status?

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* 4. Name of company?

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* 5. What is your age?

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* 6. **Referrals please*** Plaza Research Houston is looking for brokers/agents who are actively involved in selling healthcare insurance to medium to large companies. The agents/brokers will receive $350 for participating in a 1-hour telephone interview. We will be conducting interviews throughout this week (July 20th – July 24th ). Please provide the name of your agent or broker that sold the policies to your company. We are NOT looking for the insurance carrier. ie BCBS, cigna, aetna). We are looking for the agent or agency that sold the policy. Your referrals are greatly appreciated. We are offering a $50 referral fee to those that provide the names and companies of qualified and participating respondents. If you do not have a name or agency to include please type N/A in the text box.

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* 7. **IMPORTANT: PLEASE PUSH THE "DONE" BUTTON AT THE BOTTOM OF THIS SCREEN. YOUR ANSWERS WILL NOT BE SAVED WITHOUT DOING SO!**

When you click Done you will be redirected to our Facebook Page. Facebook and Plaza Research are not, in any way, connected. You also do not need to be a Facebook member in order to qualify for the study that you just applied for. This is strictly a convenience if you, our respondent, would like to "like" our page as another avenue to be notified of upcoming groups.

Thank you for participating in our survey. IF you qualify based on the answers provided THEN you will receive a call back. However due to the popularity of our surveys and groups, we can't contact everyone. Please note that all responses will be returned on a first come, first served basis until the studies are full.

*****REFERRALS ARE GREATLY APPRECIATED!*****

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