Client Intake Form

Please fill out the form below, and a cornerstone enrollment specialist will be with you shortly.

Name

First Name

Last Name

Email Address

Legal Company Name

Number of Locations

Number of Locations with 20+ Employees

Annual Turnover Percentage

Number of Full Time Employees

Number of Part Time Employees

Industry Classification

(SIC Code)

What is the open enrollment period?

What is the effective date of benefits?

YYYY

What is the waiting period for new hires?

Payroll: Please detail current payroll frequency, slots, vendor, etc.

Number of Benefit Classes

Payroll Vendor

Benefits Administration Platform

Current open enrollment format?

Check all that apply

One-On-One

Group Meetings

Self-Service

What is the eligibility period for new hires?

Current open enrollment process? Please describe:

Current on-boarding process? Please describe: