Request Form - Shepell·fgi

Health & Productivity Solutions Request Form

If you are an HR Professional looking for more information on Shepell·fgi products and services, please complete the form below.
If you are a current EAP customer and require magnets, posters or any other merchandise please email your request to promotion@shepellfgi.com

Company Name:	*
Number of Employees:
First Name:	*
Last Name:	*
Your Position:	*
Email Address:	*
City:	*
Province:
	U.S.A.
State:
Telephone Number:	*
Who is your group benefits provider?
Does your company have an employee assistance plan in place? If yes, who is your EAP provider?	Yes No
Do you have a self-administered short-term disability plan?	Yes No
* - Required field