Submit Referral

Do you know someone who might qualify for one of the BASE® products? Enter client information here and BASE® will start working for you today!

* Required

Contact Information
Are you currently working with a BASE® Benefit Specialist?
Self-Employed or Business Owner? *
Member of Association?
Please select at least one BASE® product *
BASE® HRA
BASE® Excepted Benefits
BASE® Integrated HRA
BASE® 125 Cafeteria Plan
Number of Employees?
Additional Note
  • 400 characters available.