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:
Professional Benefit Administrators
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
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