XBENEFITS Support Form

1

Full Name* This field is required.

First Name

Last Name

2

Account Email* This field is required.email id associated with your account

example@example.com

3

Best number to text you?

Please enter a valid phone number.

6

What is, or isn't happening?* This field is required.Be as descriptive as possible. This will help us identify and solve the problem.

7

Upload any screenshots or recordings that will help us understand and support.Max file size is 10.6MB

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

8

Please verify that you are human* This field is required.