Questionnaire

Please answer the following questions so we can assess our potential partnership with you. Fill out the form to the fullest extent possible. We realize not all questions will pertain to every organization and partnership.

If you have any questions about this form, please contact us at partnerships@benefitfocus.com.

Company Name *

Billing Street *

Billing City *

Billing State/Province *

ZIP Code *

Website

First Name *

Last Name *

Email *

Business Phone *

Date Founded:

How many employees do you have?

How many sales assoicates do you have?

Please describe your core business:

What is your target market?

What is your pricing model?

Who are some of your current clients?

What is your typical contract length with a client? (in months)

What is your typical implementation time?

How do you transfer/transmit data?

How often do you normally transmit data?

What file formats do you use for data transfer?

Do you have proprietary software?

What other companies do you currently partner with? Please describe those partnerships.

Is your solution multi-lingual?

If you answered "yes" to the previous question, what languages do you support?

Do you have a support call center?

What security measures do you perform with your data?

Please describe your corporate culture.

Why are you interested in partnering with Benefitfocus?

Partnership Type:

If you answered "Other" above, please explain:

If you have a specific promotional idea or partnership initiative you would like to propose, please provide a brief description:

How would you promote and support the partnership?

Please provide a summary of the anticipated benefits to Benefitfocus and your organization:

For joint opportunities, would you contract directly with the client or through Benefitfocus?

Please provide any other comments you'd like to make: