EMPOWER We are here for you! Advanced Flex Plan Administration with the Human Touch Request Changes to Employer Contacts Select a tab below to request EMPOWER to update your contact information. Add New Contact Delete Existing Contact Change Employer Portal Access Replace Contact Add New Contact Use this form to add a new Contact Employer Name(Required) New Contact's First Name(Required) New Contact's Last Name(Required) Email(Required) Phone(Required) Job Title/Role(Required) Does the new contact need Employer Portal Access?(Required) Yes No EMPOWER will email credentials if “yes” is checkedShould the new contact receive monthly EMPOWER invoices?(Required) Yes No If “yes” is checked, this contact will receive EMPOWER’s monthly administrative services invoices via email.NameThis field is for validation purposes and should be left unchanged. Delete Existing Contact Use this form to delete an existing Contact Employer Name(Required) First Name(Required) Last Name(Required) EmailThis field is for validation purposes and should be left unchanged. Change Employer Portal Access Use this form to add/remove/change Employer Portal access for an existing user Employer Name(Required) Contact Name(Required) Desired Change(Required) Add Employer Portal Access to Existing User Remove Employer Portal Acess Change Access Level Employer Portal Access Level(Required) Administrator (can make changes) Read Only NameThis field is for validation purposes and should be left unchanged. Replace Contact Use this form to add a new contact and remove an existing Contact Employer Name(Required) Existing Contact Full Name(Required) New Contact Full Name(Required) Email(Required) Phone(Required) Job Title/Role(Required) Does the new contact need Employer Portal Access?(Required) Yes No EMPOWER will email credentials if “yes” is checkedShould the new contact receive monthly EMPOWER invoices?(Required) Yes No If “yes” is checked, this contact will receive EMPOWER’s monthly administrative services invoices via email.PhoneThis field is for validation purposes and should be left unchanged.