BenefitsWorkshop

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BenefitsWorkshop
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Tools to improve the financial health of your employees.

Proposal Request Form for:
Flexible Spending Accounts (FSA);
Health Reimbursement Arrangements (HRA);
Limited-Purpose FSAs (LPFSA);
Commuter Benefit Accounts (CBA); and/or
Cafeteria Plans

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 Us" 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 in the special requirements in the Comment Section at the bottom of the form. Please send the RFP to the BenefitsWorkshop at the following address, via expedited mail, if the proposal is due in less than two weeks.

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.

SELECT THE PLAN(S)

*Type of Proposal Requested (Check all that apply):

Flexible Spending Accounts (FSA)
Health Reimbursement Account (HRA)
Limited-Purpose Flexible Spending Account (LPFSA)
Commuter Benefit Accounts (CBA)
Cafeteria Plan

INFORMATION ABOUT THE EMPLOYER

*Name of Employer:

*Address:

*City:

*State:

*Zip Code:

*Number of Eligible Employees:

*Nature of Business:

*Type of Organization:

*Does the employer currently have the plans indicated above?

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:

Coupon Code (if any):

Comments: