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Client Information

Please complete and submit the Client Information form.

Which role describes you best?

Select an option

Employer Information

Additional Information

Do you need assistance with a Section 125 Cafeteria Plan Document?
Are there any other employers participating in this benefit plan?
Pre-Tax Benefits offered:
Does the Plan Sponsor use a TPA for administering the FSA benefit?
Does the FSA run on the same plan year as the major medical benefits?
Which of the following does the employer allow at the end of the FSA plan year?

Thank you for submitting your information!

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