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Section 125 Premium Conversion (POP) Plans
Flexible Spending Accounts (FSAs)
Health Reimbursement Accounts (HRAs)

Flexible Spending Account (FSA)/Health Reimbursement Arrangement (HRA)
Proposal Request Form

Please complete the form below. It generally takes three to five business days for you to receive a proposal via e-mail. On occasion, we may have follow-up questions. We will submit these questions to you via e-mail. You may check on the status of your proposal by clicking any "Contact BenefitsWorkshop" button on this site.

If you need a non-standard proposal, a hardcopy proposal, or if there is a formal Request For Proposal (RFP), please complete the form, allow two weeks for processing in the due date field, and indicate any special requirements in the Comment Section at the bottom of the form. Please send the RFP to the Arison BenefitsWorkshop at the following address, via expedited mail, if the proposal is due in less than two weeks. :

Proposal Request
Arison BenefitsWorkshop
P. O. Box 56828
Jacksonville, FL 32241
(904) 631-2629

Please enter the information below and press the "Submit" button. All fields marked with an asterisk (*) are required.

INFORMATION ABOUT THE EMPLOYER
*Type of Proposal Requested:

*Name of Employer:

*Address:


*City:

*State:

*Zip Code:

*Number of Eligible Employees:

*Nature of Business:

*Type of Organization:

*Does the employer currently have a Flexible Spending Account Plan and/or Health Reimbursement Account Plan?

INFORMATION ABOUT YOU
*Your Name:

*Your Company (if different than above, or "N/A"):

*Title:

*Phone:

*Fax:

*E-mail:

*Date needed - MM/DD/YYYY (please allow at least 3 days, 5 is preferable):

*You are the:

*Referred by (Name of Arison representative):

Comments: