COBRA Template Request Step 1 of 2 50% Submit a Template Request by Completing the Below QuestionsTemplates are only necessary for employers who began monthly COBRA administration services with Admin America after November 1, 2019.Employer Name* Authorized Representative's Name* First Last Authorized Representative's Email*The details of your submission will be sent to the email address provided below. Additional Email(s) (optional)The details of your submission will be sent to the email address(es) provided below. To send to multiple email addresses, separate the email addresses with a comma. Template RequestCheck the box below to request the template I need a template Δ
