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Intake Form
First, choose a date and time.
About You
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Contact Name*

First NameLast Name
Contact's Title*
Contact's Email Address*
example@example.com
Contact's Phone Number
Please enter a valid phone number.
Contact's Preferred Language*

EnglishEspañol
About Your Business

The information you provide below will help us tailor our services to your needs. If you feel stuck, no worries! We are here to help guide you in the right direction. Please fill out as much as you can.
Business Name*
Business Phone Number*
Please enter a valid phone number
Business Email (if different than Contact Email)
example@example.com
Which email address above do you prefer AXA to use?*

Business EmailContact's Email
Employer Identification Number (EIN)
Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What Industry are you in?
If "Other," please explain below.
What are your products and services?
Questionnaire

Before we meet with you, Let's explore how AXA can help your business!
What is the preferred language of your employees?*

EnglishEspañolA mixture of both languages
How many employees work for your business, including yourself?*
How many independent contractors work for your business?*
This number is separate from the number of employees.
How many locations does your business have? (If multiple locations, please provide addresses)
In which state(s) does your business operate in?
(e.g. CA, AZ, OR, etc.)
Which AXA solution(s) are you interested in?

Outsource Human Resources Management so that I can free up my time to grow my businessAuditing and setting up an HR DepartmentPerformance management coachingBuilding training and development programsSupport with updating manuals, handbooks, and/or policiesTranslation of HR documentsRecruiting and employee onboardingManaging Workers Compensation ClaimsConducting Employee Relations InvestigationsI have a specific project in mind that my team does not have the bandwidth to accomplish aloneOther
Please use this space to elaborate more on what AXA can help you with.
What stage is your business in?

🤔I'm trying to start a business.🙂I recently started my business.😍I have a business that is fully operational.😨My business is (or is about to be) in financial or legal trouble.🧐I am restructuring my business.🤑I am retiring/selling/closing my business.
What do you need help with?

I am having a hard time finding/keeping employees that fit my business needs.I don't know if my business is compliant with labor lawsI don't know how to organize my files and documentationMy employees only speak Spanish and I don't know how to help them with their employment-related questions.I'm having issues with employee behavior.I need to find a more efficient way of paying my employees.I do not know how to legally start my business
Which AXA solution(s) are you interested in?*

*Human Resources Consulting* (Employment law compliance, company policies, payroll, benefits, workers compensation, recruiting, onboarding, organizational development, training and development, team building, employee engagement, investigations, performance management guidance, risk management, HR department set up and outsourcing, management coaching, etc.)*Business Solutions* (Business plan, business structure, insurance and liability, marketing and research, guidance on how to start your own business etc.)*English/Spanish Document Translation**English/Spanish In-Person Training*I'm not sure where to start.
If what you are looking for is not listed above, please provide some additional information/comments
Feel free to leave us an audio message if you'd like to provide additional information.
We look forward to working with you!
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Schedule your free consultation with AXA!

About You

About Your Business

Questionnaire

We look forward to working with you!