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GENERAL INFORMATION
Name:
Email:
Company Name:
Federal ID#:
Description of Business:
Years in Business
Contact Person:
PAYROLL INFORMATION
State Unemployment Tax Rate? (SUTA)
Workers' Compensation Carrier:
Expiration Date
Workers' Compensation Rating:
BENEFITS INFORMATION
Health Care Provider:
Expiration Date:
Do you offer any retirement benefits?
401K
Traditional IRA
Roth IRA
Would you like information about offering these?
401K
Traditional IRA
Roth IRA
Estimated time your staff spends administering payroll workers' compensation, benefits, quarterly reports, and other Human Resources duties? (hrs/payroll)
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