Create Your Simple Plan
Fill out this form to create a new Simple Plan for your employees. Once submitted, a support manager will reach out to confirm final details. No charges will be made until you plan is live and members are uploaded.
For any questions, email firstname.lastname@example.org.
Name of Client/Company Implementing Bento
Your/Company Phone Number
Please enter a valid phone number.
Number of Employees at Company
When do you want to launch the plan?
Street Address Line 2
State / Province
Postal / Zip Code
Your/Company Tax ID
The TIN, EIN, or SSN of your business
Any questions about this plan?
Your support manager will review your questions and reach out to you before creating the plan.
Banking details will be needed before members can be uploaded into Bento. To prevent any delay in your plan setup, please fill out the details below.
Bank Account Holder's Name
Bank account is used to deduct all claims as well as the monthly fee.
Contact for Bank Verification
Bento will be verifying the bank account with two test deposits. Please enter the name and contact details of whom bento should reach out to in order to complete verification.
Bank Account #
Bank Routing #
Should be Empty: