Home
Employers
Employee Retention Credits
Submit Documents Online
Employee Labor Release / Separation Form
Employer Forms Library
Employer Safety Resources
Employer Tutorials
Employer Monthly Campaigns
Employer Newsletters
Employer Helpful Links
Employees
Employee Portal
Employee Forms Library
Employee Tutorials
Employee Monthly Campaigns
Employee Newsletters
Employee Helpful Links
Submit Documents Online
Resources
Employee Enrollment
Independent Contractors
New Clients
News & Events
Tax Forms
Webinars
Blog
Helpdesk
X
Focus Card Enrollment Form
Name
*
First
Last
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone
*
Birth Date
*
Social Security Number
*
What is the dollar amount or percentage of pay you would like to go on this card each pay period?
*
Percent or Dollar Amount?
*
Dollar Amount
Percentage
Email
*
Date
*
Date Format: MM slash DD slash YYYY
X