Select Employee Group (SEG)

Company Information (Required fields are indicated by an asterisk *)
* Company Name:
* Type of Business:
* Year Established:
* Contact Person:
* Contact's Title:
Contact E-Mail Address:
* Physical Address:
Suite Number:
* State:
* Zip:
Mailing Address (if different):
Suite Number:
City:
State:
Zip:
* Business Days:	through
* Business Hours:	to
Shifts (if applicable):
* Phone Number:
Fax Number:
* Number of Full-Time Employees:
* Number of Part-Time Employees:
Does your company currently offer credit union membership as an employee benefit?	Yes No
If yes, name of credit union:
Do you offer Direct Deposit?	Yes No
Do you offer an employee benefits day at which we might participate?	Yes No
Dates:
Do you publish an employee newsletter?	Yes No
May we insert promotional or educational articles or ads?	Yes No
May we insert information in your payroll checks?	Yes No
Do you have a bulletin board where we can place information?	Yes No
Location:
Are you interested in having financial planning seminars at your company location for your employees?	Yes No
Are you interested in having us speak to your employees at your facility?	Yes No

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