Common Contracts
2 similar null contracts
isolved Benefit Services Service AgreementSeptember 21st, 2020
Employer Legal Name– Please print (“Employer”) Federal Employer Identification Number (FEIN) isolved Customer Account Number (Please include on check when sending in payment) Number of Benefits Eligible Employees Number of Benefits Enrolled Employees Number of Reporting Locations Address City/State/Zip Phone number Fax number Nature of business Primary Contact Telephone E-mail address All Svcs COBRA only FSA only PHI Contact Secondary ContactReports All Svcs COBRA FSA PHI Contact Telephone E-mail address Implementation Contact (if other than primary contact) Telephone E-mail address Agency Contact Telephone E-mail address
isolved Benefit Services Service AgreementSeptember 21st, 2020
Employer Legal Name– Please print (“Employer”) Federal Employer Identification Number (FEIN) isolved Customer Account Number (Please include on check when sending in payment) Number of Benefits Eligible Employees Number of Benefits Enrolled Employees Number of Reporting Locations Address City/State/Zip Phone number Fax number Nature of business Primary Contact Telephone E-mail address All Svcs COBRA only FSA only PHI Contact Secondary ContactReports All Svcs COBRA FSA PHI Contact Telephone E-mail address Implementation Contact (if other than primary contact) Telephone E-mail address Agency Contact Telephone E-mail address
