We're There When You Need Us...Unparalleled Solutions - Prompt Response







Request For Proposal

Please enter the following information:

Organization Name:
Street Address:
City:
State:
Zip:
Website Address:
Type of Business:
Number of Employees:
Multiple Locations:
 Yes No
If Yes, where are they located?
Does the company have an existing EAP?
 Yes No
Session model requested:
(you may request pricing on more than one)
1-3 1-5 1-6 1-8 Other
If other, please specify:
Interest in additional services:
* Some services are included in standard EAP proposals and contracts.
Organizational Development Corporate Training & Development
Work-Life Elder Care/Child Care
Corporate Health Programs Substance Abuse Program Management/DOT Compliance
Crisis Management/
Debriefing*		 On-line Services*
Risk Management    
Other information that would be helpful:
Proposal needed by what date:
 * Format: MM/DD/YY
Program implementation date:
 * Format: MM/DD/YY
How did you learn about Human Development Company, Inc.?
Brochure/Marketing
Word of Mouth
On-line search
Previous work with company
Contact Name:
Title:
Email:
Phone:
Fax:

If the contact above is a Broker, Consultant or TPA, please complete the following. We will only make contact with your client company if requested by you or the company.
Company Name:
Address:
City:
State:
Zip:
Any additional requests:
Thank you for the opportunity to provide services to your company.

Human Development Company BBB Business Review