Forms





Completed forms should be mailed to:

Eagles, Benefits by Design, Inc.
2336 SE Ocean Blvd., Suite 301
Stuart, FL  34996

You may also fax the form to:
(772) 334-7059
Please select the form you would like below.  You can type in your information and print the form, or print a blank form and write in your information.

All of our forms require Adobe Acrobat Reader.  If you do not have it, you can click the button below.

HyperLink

Flexible Spending Forms
     Flexible Spending Brochure
     Flexible Spending Worksheet
     ACH Direct Deposit Form
     Flexible Spending Claim Form
     Flexible Spending Enrollment Form
     Quick Pay Child Care 

Dental Forms
     Dental Enrollment Form
     Dental Claim Form

Vision Forms
     Vision Enrollment Form
     Vision Claim Form
     For a provider list click HERE