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Cleggs Pest and Termite Control Worksheet
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Employee NameWork Location:
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Current BenefitsCurrent DeductionsNew BenefitsNew Deductions
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MEDICAL NATIONAL PLANMEDICAL NATIONAL PLAN
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Principal DentalDENTAL SILVER PLAN
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Principal VisionVISION SILVER PLAN
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Short-Term DisabilityShort-Term Disability
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AccidentAccident
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GUARDIAN HOSPITAL INDEMNITYGUARDIAN HOSPITAL INDEMNITY
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Critical IllnessCritical Illness
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Life InsuranceLife Insurance
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Legal Plan
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Flexible Spending Account
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Company Life Insurance
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Identity Fraud
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Employee Assistance
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Pet Solutions
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Free Prescription Card - InSource Rx®
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Discounts on Auto & Home Insurance
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Member Discounts
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TotalTotal
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SignDate
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