Business Enrollment Form

Please complete the employer enrollment form below. Once submitted, Balanced Healthcare will contact you within 1–3 business days to review the business membership agreement, finalize your account setup, and schedule employee onboarding.

Business Name *

Business ID Number *

To qualify for our business membership rates we need to verify that you are in good standing with the Colorado Secretary of State. Please locate your business ID number. You can find it here: https://www.coloradosos.gov/biz/BusinessEntityCriteriaExt.do

Authorized Employer Representative

First Name *

Last Name *

Email *

Phone Number

Billing Address *

City *

State *

Postal code *

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