Payroll Service Application Please fill out as much information as possible on the form provided below. This preliminary information will be sent directly to our partnered payroll provider. A payroll account specialist will schedule an appointment with you to confirm pricing and begin the process of enrolling your company for online payroll. NOTE: If you are not contacted within 2 business days, please contact our sales department.Company InformationContact Name* Company Name* Address* Street Address Address Line 2 City Enter your StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Best Time to ContactAnytime8:00AM-12:00PM12:01PM-3:00PM3:01PM-6:00PM6:00PM-8:00PMOther InformationFor how many employees do you need the payroll service?In how many states do you file payroll taxes?How often will you process payroll for your employees? Weekly Monthly Biweekly Semimonthly How are you currently handling your payroll services? In-house Accountant or bookkeeper Payroll Service HR company Not currently processing payroll Other What is your timeframe for converting to our online payroll services? ASAP In two weeks In one month In two months Other What other optional payroll services might you be interested in? Check printing and delivery Workers Compensation plan 401(k) plan administration Section 125/cafeteria plan administration Please describe any additional requirements you have as well as the name of the company who currently handles your payroll, if applicable.
