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Employee Benefits AnalysisPERSONNEL DEPT.> OFFICIAL COMPANY ORDER FORM No:____________ TOTAL COMPANY EMPLOYEE BENEFIT ANNUAL CONTRIBUTION CONTRIBUTION COST BENEFIT Retirement Plan $............ $............ . ....... Deferred Compen. $............ $............ . ....... Incentive Stock Op. $............ $............ . ....... Disability Insur. $............ $............ . ....... Health Insurance $............ $............ . ....... Group Life Insur. $............ $............ . ....... Dental Insurance $............ $............ . ....... Education Benf. $............ $............ . ....... Profit - Sharing $............ $............ . ....... Performance Bonus $............ $............ . ....... Scholarship Aid $............ $............ . ....... Relocation Expense $............ $............ . ....... Group Legal $............ $............ . ....... Wage Continuation $............ $............ . ....... Child Care $............ $............ . ....... Club Memberships $............ $............ . ....... Stock Options $............ $............ . ....... Stock Purchase Plan $............ $............ . ....... Pai-Up Annuities $............ $............ . ....... Low-Interest Loans $............ $............ . ....... Company Car $............ $............ . ....... Financial Counsel. $............ $............ . ....... Other: $............ $............ . ....... * This Form is to be kept on file - PERSONNEL DEPARTMENT.
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