Toggle navigation
Employees
& Families
Managers
& Human
Resources
Brokers &
Prospective
Clients
Personal
Advantage
Website
Positivity
Center
Information
for Providers
About
Us
Contact
Us
Request a Proposal
Please complete and submit this form and we'll have a proposal back to you as soon as possible, typically within one business day.
* Asterisk indicates required field
First name*
A first name is required.
Last name*
A last name is required.
Phone number*
A phone number is required.
Please enter a valid US phone number (ten digits).
Email address*
An email address is required.
Please enter a valid email address.
Which applies to your request?
Please make your choice.
I am a broker/consultant requesting a proposal for an employer group I represent*
Broker/consultant company name*
A broker/company name is required.
Broker/consultant company street address
(city, state, zip)*
A broker/company address is required.
I am requesting a proposal for my own organization*
Your title
Your title is required.
Please enter this information about the employer group seeking an EAP
Name of organization*
An organization name is required.
Street address (city, state, zip)
Website
Number of employees
Is there currently an EAP in place?
Yes
No
If yes, what is the name of the EAP?
Proposed effective date
Primary location of employees
Please provide any additional information helpful in preparing the proposal.