Company Name

Company FEIN Number

Contact Name / Position

Company Address

Contact Phone Number

Contact Email Address

Payroll Administration

How many FEIN numbers will you require servicing?

Total Employees

States currently active

Pay Cycle Frequency Payroll check day Payroll ending day

Payroll data will be exchanged via:

Please Select Internet Fax Phone Excel Spreadsheet

Do employees receive compensation via:
 

Commissions
Tips

How are vacation, sick time or paid-time-off calculated?

What is your current accounting structure?

Please Select By Location By Job / Project By Job Title By Department

Do you utilize a paycheck debit card for unbanked employees?

Please Select Yes No

Human Resource Essentials

What is the number of W-2's last year?

Annual turnover percentage

Is there currently an HR professional(s) on staff at your Company?

Please Select Yes No

If no, who handles the compliance area of your Company?

How many unemployment claims per month?

What is the average employee tenure at your Company?

Is your business compliant with:
 
 

Employee Handbooks
FMLA Administration
Safety / OSHA

What HR areas do you track monthly?

Is Human Resources strategic in your Company?

Please Select Yes No

Estimated annual cost of outside council or consulting in the HR area?

Benefit Essentials

How many benefit carriers do you currently utilize?

What is your benefit deduction frequency?

Who currently audits benefit invoices, makes corrections/deletions within your Company?

Does your Company have a Section 125 Cafeteria Plan?

Please Select Yes No

What percentage of employees are enrolled on:

Group Major Medical Plan

Additional Life

Group Dental

STD

401(k)

Supplemental Insurance

Does your current Employee Benefit Package meet your goals of:

Reducing turnover

Cost control

Increasing longevity

Creating Company loyalty

Well received by current employees

Please Select Yes No

Please Select Yes No

Please Select Yes No

Please Select Yes No

Please Select Yes No

Would you like more information on employee benefit strategies?

Please Select Yes No

Risk Essentials

How often do you remit workers compensation premiums?

Does your carrier require audits?

Please Select Yes No

Does your Company have a safety manual and provide safety training?

Please Select Yes No

Who prepares your OSHA 300 Log?

Would your Company like more information regarding the latest workers compensation products?

Please Select Yes No

1099 Contractor Administration (if applicable)

How many 1099's are currently being utilized?

What is the pay frequency of your 1099's?

Do you offer direct deposit payment for 1099 Contractors?

Please Select Yes No

What is the accounting structure for 1099 wages?

Do your 1099 Contractors have related business deductions?

Please Select Yes No

New Client Enrollment

Will employee wage and year-to-date tax information be provided in an electronic format to us? If no, how will you provide?

Please Select Yes No

Would you like your current year-to-date tax returns reviewed for accuracy?

Please Select Yes No

Will you enter employee data via our internet website or would you like us to enter the information?

Please Select I will enter on your website Please enter for me

What is the desired service implementation date?

I would like a Company Representative to contact me

Please Select Yes No