Employer Request for Proposal

Counselling and Referral Services

Employer Request for Proposal

Please complete and submit the form below to request a proposal for your company. Note: This form is for price quotations only.

Dolly and Associates Ltd. is pleased to prepare a detailed EAP Proposal/Quote outlining our services. To best assist you, please fill in “all” fields with the required information. You can expect a response and quote normally within five business days. If you have any questions, please call us at 1-868-627-1845 or send email to eap@dollyandassociates.com.

Company Name*
Headquarters/Branch Location*
Company Address*
Street Address Address Line 2 City Country
Name*
Prefix First Last
Title*
Business Phone*
Email*
Company Website*
Preferred contact method?*
Best Time to Contact You*
How did you hear about us?*
May we contact the person who referred you?*
Contact Name*
First Last
Contact Phone #*
Number of Employees*
Desired EAP Starting Date:*
MM slash DD slash YYYY
Requested Counseling Sessions*
Which EAP Services Interest You Most? (Select all that apply)*
- Counseling Services
- Work/Life Services
- Workplace Resilience Tools
- Organizational Support
- Other
Do you have a current EAP provider?*
EAP Provider*
Reason You Are Looking for EAP?*
Anything Else?*
Email
This field is for validation purposes and should be left unchanged.

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