Preliminary Client Questionnaire Company Name:*How did you hear about us?*Contact Information Company Contact Name:*Company Contact Phone:*Company Contact Email:*Employees and Classification Enter the number of W-2s issued to:Full Time Employees:*Part Time Employees:*Other Employees:*Do you have Temp Staff?*YesNoDo you have Seasonal Staff?*YesNoFor the purposes of this questionnaire, seasonal employees are ones that are only employed for a portion of the year; an employee that works all year but has periodic times of increased hours (such as a retail employees during the holiday season) is not considered seasonal.Do you have Variable-Hour Staff?*YesNoFor the purposes of this questionnaire, a variable-hour employee is one who works dramatically different hours from week-to-week, so that the 30 hour/week threshold for full-time employment is not regularly exceeded. Example: a waitress working 15 hours one week and 45 the next is variable-hour; a mechanic working 38 hours one week and 45 the next is not.Medical Insurance Information Do you offer medical insurance to your employees?*YesNoGeneral Information: Describe how employees pay for coverage:*Explain coverage as if you were telling a new hire about your benefit plan.Does the company have any other related companies?*YesNoWith Common OwnershipHave you had any major changes to your plan in the past 12 months?*YesNoSuch as a new or cancelled plan, a new or sold company, dramatic overhaul of benefits offered or cost structure at renewal, etc.Anything else we should know, or concerns? This iframe contains the logic required to handle Ajax powered Gravity Forms.