STEP 2 OR STEP 3 – REMAINS AFTER WELCOME CALL – Easy/Quick Join – We’re proposing to have payment here.

not taking money until quote accepted, unless they don’t want health insurance and then payment will be after phase 2 form skipping health data

Join Non-CFA Phase 1

"*" indicates required fields

STEP 4

Join Non-CFA Phase 2

"*" indicates required fields

This field is for validation purposes and should be left unchanged.

Your Position*

Business License Date*

When would you like your health insurance benefits to begin?*

FEIN/Tax ID*

Add multiple by using the + icon to the right.

Address Associated with FEIN

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Store Location(s)*

Note: If you have multiple FEINs, you will be treated as one entity based on common ownership.

Street Address

City

State

Zip Code

Total Employees

Store Opening Date

Number of Employees*

Employment Positions Type(s)*

Select All

Full Time

Part Time

Seasonal

In order to properly provide coverage and maintain COBRA compliance;
GIOA will need to receive your employee demographics on a weekly basis.
Members typically connect GIOA with their Payroll Provider Contact.

Payroll System in Use*

Payroll Provider Contact Name*

First Last

Payroll Provider Contact Email*

Payroll Provider Contact Phone

Upon submitting this form, you will soon be contacted by a GIOA Member Advocate who can answer any questions you may have about your new GIOA Membership.

NEED BLURB ABOUT DEMOGRAPHICS/CENSUS DATA - they will be directed to that (email in their inbox) after submitting this form)

Welcome to GIOA!

Check out these useful videos to learn all about your next steps and action items.

1. Your Dashboard

2. Operator Strategy

3. VendorBridge

4. Add an Admin

5. Next Steps

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Join Non-CFA

Next Steps: Install the User Registration Add-On

STEP 2 – Health Insurance Election & Enrollment Eligibility – CHANGE:

Non-CFA Expansion Health Insurance Single Steps

End of STEP 3 – (CONFIRM: remove pmt until last step/quote acceptance) full stop – confirmation is thanks we’ll be in touch with quote

STEP 2 OR STEP 3 – REMAINS AFTER WELCOME CALL – Easy/Quick Join – We’re proposing to have payment here.

Join Non-CFA Phase 1

Next Steps: Install the User Registration Add-On

STEP 4

Join Non-CFA Phase 2

In order to properly provide coverage and maintain COBRA compliance;
GIOA will need to receive your employee demographics on a weekly basis.
Members typically connect GIOA with their Payroll Provider Contact.

Welcome to GIOA!

2021 Job Title Change

Join Non-CFA

Next Steps: Install the User Registration Add-On

STEP 2 – Health Insurance Election & Enrollment Eligibility – CHANGE:

Non-CFA Expansion Health Insurance Single Steps

End of STEP 3 – (CONFIRM: remove pmt until last step/quote acceptance) full stop – confirmation is thanks we’ll be in touch with quote

STEP 2 OR STEP 3 – REMAINS AFTER WELCOME CALL – Easy/Quick Join – We’re proposing to have payment here.

Join Non-CFA Phase 1

Next Steps: Install the User Registration Add-On

STEP 4

Join Non-CFA Phase 2

In order to properly provide coverage and maintain COBRA compliance;GIOA will need to receive your employee demographics on a weekly basis. Members typically connect GIOA with their Payroll Provider Contact.

Welcome to GIOA!

In order to properly provide coverage and maintain COBRA compliance;
GIOA will need to receive your employee demographics on a weekly basis.
Members typically connect GIOA with their Payroll Provider Contact.