NEW GROUP SIGN UP This form is intended for new employer groups signing up with Cascade EAP. If you found this form by mistake or need assistance with signing up a new group please email info@cascadecenters.com or call 800-433-2320.
EAP New Group Sign Up Your Email Address (required)• We will not send unsolicited email nor share your email address with anyone. Ever. General Information(required)• First Name (required)• M.I. Last Name (required)• (required)• Title(required)• Phone(required)• DBA Company Name(required)• Legal Company Name (If different from above) Address(required)• Accounts Payable(required)• Accounts Payable Name(required)• Title(required)• Phone(required)• Email(required)• Company and Benefits(required)• Industry Type(required)• Number of eligible employees(required)• Eligibility Criteria(required)• All Employees Benefit Eligible Employees Only Other Eligibility Criteria:If you answered "other" please provide additional information Eligibility Criteria: Other Multiple Locations(required)• Yes, we have multiple locations No, we only have one location If you answered "yes" please provide the city and state of each location in the "locations" section below. Or you may email your account manager your list. Locations (required)• Health Insurance(required)• EAP Services Contact your account manager for pricing questions. Additional EAP Services LifeBalance Wellbeing Program WholeLife Directions (WLD) Broker Information Brokerage Company Broker Name Address Phone Email Account Manager Account Manager Phone Account Manager Email Date Renewal information is due to Broker Renewal information will be sent 90 days prior to renewal unless otherwise requested. Additional Information Please share any additional information Please Don't Enter Anything In This Space
