Company Name*:

Address*:

City*: State*: Zip*:

Contact Name*:

Phone Number*:

Email Address*: Website:

Number of employees:

Gross Payroll: weekly biweekly monthly semimonthly

Payroll cycle: weekly biweekly monthly semimonthly

Current Payroll Method: Inhouse Accountant Payroll Service

Delivery Method Preferred: FedEx/UPS overnight FedEx/UPS standard Delivery (if applicable) Pick Up (if applicable)

Service Interested In: Payroll Processing PEO Service General Liability Workers Compensation HR Outsourcing