Your & Family Employers

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Account Activation

Your LyfeVault can combine money contributed by one or more employers for an individual or family. Here we ask for information on existing employers who have established a LyfeBank plan, and those which may be eligible to establish plans for the benefit of a worker and family. We also request access to a personal bank account both to handle reimbursements electronically and to ensure seamless payments of health insurance premiums when LyfeVault funds are not available. We will hold this information in strictest confidence. To provide your individual or family bank account information, click HERE.

Worker and Worker's Current Employer(s)

Employee Contact Information

Please provide the following information so we may activate your LyfeVault™. With this information we will confirm your eligibility for healthcare contributions from the listed employers. If you would prefer to provide this information directly by phone, please call LyfeBank Customer Support at 1-360-466-9100. This information is transmitted directly to us and we do not share it with outsiders.

First Name:
Last Name:
Address Street 1:
Address Street 2:
City:
Zip Code:	(5 digits)
State:
Phone:
Email:
Social Security Number:

For a form to provide us with contact information for the worker's employer(s), click HERE. Please submit information for each employer on a separate form.

Family Members and Family Member Current Employer(s)

For a form to provide us with contact information for employers of the worker's spouse and dependents (if any), click HERE. Please submit information for each employer on a separate form.