Payroll Services

Tax & Compliance

Benefits Administration

Time & Labor Management

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*Company Name

*Address

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# of Employees Years in Business

I am interested in these services:

Basic Payroll & Tax Service
Direct Deposit
Employee Benefits
Human Resource Services
HR Services

Health or Dental Insurance
Retirement Plan
Tax Credit Services
Time & Attendance
Workers Compensation Insurance
Other

Tell us about your payroll and workers' compensation breakdown

For an accurate quote, we need to break down your employees into Workers' Compensation class codes. If you know your 4 digit class code (example: Clerical employees = 8810) then enter that number below with the corresponding number of employees and approximate weekly gross wages. If you don't know the class code, just give us a job title

Workers' compensation Experience Modification Rate:

Job Performed	# Employees	Comp Code	Annual Payroll	Rate Per $100
			$	$
			$	$
			$	$
			$	$
			$	$
# of Comp Claims Last Year		$ Value of Claims		$

Unemployment and PEO History

Current State Unemployment Tax Rate:
# of Unemployment Claims Last Year:

Current PEO Admin Fee:

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