CIP HR Solutions Group
HR Services Designed for Small Business
Order form
Please complete the form below to order.

 

Company Name:
Street Address:
City:
State:
Zip:
Phone:
Fax:
Contact Name:
Contact e-mail:
 Form of Business:C-Corp
 S-Corp 
 LLC
 Sole Prop
 Partnership
 Other
Number of Employees:
Federal ID Number:
State Incorporated:
 Benefits Offered:Health Insurance
 Dental Insurance
 Life Insurance
 Disability Insurance
 Other Insurance
Requested Effective Date:
 First Plan Year:12 Consecutive Months
 To end of calendar year
Employee Eligibility:Employees working more than  hours per week
Waiting Period:First of month following  days
Chamber Membership:
Chamber Membership Number:
 Plan Options (Select one)

 Chamber Members

HR Survival Kit: Chamber ($595 Set Up & $295 Annual Document Maintenance)

Premium Conversion Kit: Chamber ($0 Set Up & $100 Annual Document Maintenance)

 Non-Members

HR Survival Kit ($795 Set Up & $395 Annual Document Maintenance)

Premium Conversion Kit ($250 Set Up & $150 Annual Document Maintenance)
 
Copyright 2007. CIP HR Solutions Group. All rights reserved.