PROSPECT REFERRAL Please Complete the Form Below Please enable JavaScript in your browser to complete this form.Company Contact NamePerson we will follow up withCompany Contact EmailEmail we will reply toDeel Staff Member EmailCompany Name:State of USA HeadquartersAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingCompany IndustryNumber of current benefit eligible employees?In what state(s) are the majority of your employees located?What is the expected date you plan to move employees to USA entity? (use best estimate)Please select the types of benefits you are interested in exploring for your employees. (select all that apply)MedicalDentalVisionLife / AD&DLong Term DisabilityShort Term DisabilityFlex Benefits (Health FSAs, Dependent Care FSAs, Commuter)Other/UnknownOptional, please feel free to share any notes with our representatives in the space below:Submit
