Professional Benefit Administrators

PROFESSIONAL BENEFIT
ADMINISTRATORS

1130 Hurricane Shoals Road NE
Suite 2300
Lawrenceville, GA 30043

Phone: (770) 963-3939
(800) 578-2082
Fax: (770) 963-6126
(888) 264-6975

ENROLL NOW!

Click and print the two forms below, and mail or fax to:

Enrollment Forms

Enrollment Form
Method of Payment

Agent Forms
B4 Form
PDA2 Form
B4BD Form
1199A Form

AFLAC Agent Forms
B4 DED Federal
B4 Split Allotment

Professional Benefit Administrators
1130 Hurricane Shoals Road NE
Suite 2300
Lawrenceville, Georgia 30043

Phone: (770) 963-3939 or (800) 578-2082

Fax: (770) 963-6126 or (888) 264-6975

Contact us at: info@professionalbenefitadmins.com