Questionnaire Web Form Services Payroll Time and Attendance Onboarding Benefit Admin ACA HR LMS Hire Please select at least one service. Basic Information Company Legal Name * Please provide a valid value. DBA Please provide a valid value. What Company Name should be printed on the Check? Please provide a valid value. Company Phone Please provide a valid value. Company Fax Please provide a valid value. Company Website Please provide a valid value. Business Description Please provide a valid value. NASIC Code Please provide a valid value. Business Address Information Business Legal Address Please provide a valid value. Business Legal City Please provide a valid value. Business Legal State Please provide a valid value. Business Legal Zip Code Please provide a valid value. Mailing Address Same as Legal Address Which address would you like the checks/reports sent to? Business Legal Address Mailing Address Please select a valid value. Mailing Address Please provide a valid value. Mailing City Please provide a valid value. Mailing State Please provide a valid value. Mailing Zip Code Please provide a valid value. Corporate Officer Information Corporate Officer First Name * Please provide a valid value. Corporate Officer Last Name * Please provide a valid value. Phone Please provide a valid value. Email * Please provide a valid value. Preferred Method of Contact: Phone Email Please select at least one method. Authorized Contacts Information Contact 1 Name Please provide a valid value. Contact 1 Phone Please provide a valid value. Contact 1 Email Please provide a valid value. Contact 1 Responsibilities Payroll Billing HR Onboarding Benefits Time Please provide a valid value. Is Contact 1 an Owner? Do you want this contact to have access to reporting/portal access? No Yes Please select a valid value. Contact 2 Name Please provide a valid value. Contact 2 Phone Please provide a valid value. Contact 2 Email Please provide a valid value. Contact 2 Responsibilities Payroll Billing HR Onboarding Benefits Time Please provide a valid value. Is Contact 2 an Owner? Do you want this contact to have access to reporting/portal access? No Yes Please select a valid value. Business Identification Information FEIN Number Please provide a valid value. State ER If different from FEIN Please provide a valid value. Additional State Registration & Number Please provide a valid value. Status Unemployment Insurance Information Is Company registered for SUI? No Yes Applied For Please select a valid value. SUI Number Please provide a valid value. SUI Rate (%) Please provide a valid value. Payroll Dates Information Processing Frequency -None- Weekly Bi-Weekly Semi-Monthly Monthly Please select a valid value. Payroll Period Start Day -None- Monday Tuesday Wednesday Thursday Friday Saturday Sunday Please select a valid value. First Pay Period Start Date Please provide a valid value. Payroll Period End Day -None- Monday Tuesday Wednesday Thursday Friday Saturday Sunday Please select a valid value. First Pay Period End Date Please provide a valid value. Payroll Period Process Day -None- Monday Tuesday Wednesday Thursday Friday Saturday Sunday Please select a valid value. First Process Date Please provide a valid value. Payroll Period Delivery Day -None- Monday Tuesday Wednesday Thursday Friday Saturday Sunday Please select a valid value. First Delivery Date Please provide a valid value. Payroll Period Pay Day -None- Monday Tuesday Wednesday Thursday Friday Saturday Sunday Please select a valid value. First Pay Check Date Please provide a valid value. Processing Method Client will Call In Client will Email Premier Client will Use Spreadsheet Client Wants Premier to Call Them Run Auto Client will Fax Self Service - Client will Process Themselves Time Clock Integration Please select a valid value. Processing Method Details Please provide a valid value. Number of Employees Please provide a valid value. How do you collect employee time punches currently -None- Manually POS Timekeeping Software Will be using Premier's Time Other Please provide a valid value. Please provide the name of the company used Please provide a valid value. Will you use Direct Deposit? Who will you use direct deposit for? -None- All Employees Some Employees Please select a valid value. What should we do if check date falls on a weekend or bank holiday -None- Day Prior Next Business Day Please select a valid value. Do you currently have your payroll GL uploaded to your accounting software? -None- Yes No What accounting software do you use -None- Quickbooks Desktop Quickbooks Online Other New Hire Entry Method Send info to Premier to Enter Will enter via Self Service Will use Electronic Onboarding Bank Account Information Need voided check from Payroll Account Bank Name Please provide a valid value. Routing Number Please provide a valid value. Account Number Please provide a valid value. Starting Check Number Something that will never coincide with any manual checks you may write. Please provide a valid value. Do you want all fees pulled from main Account? Do you want your signature to be printed on all live checks? No Yes Please select a valid value. Is Company processing entries on behalf of another Third-Party Sender? No Yes IF Yes, Explain Does Company use foreign funds for either settlement or receipt of payroll No Yes Check Format? -None- Sealed Check-Stub Please select a valid value. What account are physical checks drawn on? -None- Operating Payroll Other Please provide a valid value. Benefits & Deductions Information Deductions Child Support Wage Garnishments 401K IRA Medical Is there a 401k? -None- Yes No Please provide a valid value. If yes, Provide more 401k Details Please provide a valid value. Do you have a current PTO policy? -None- Yes No Please provide a valid value. Current PTO Policy Details Please provide a valid value. Do you have a current Sick policy? -None- Yes No Please provide a valid value. Current Sick Policy Details Please provide a valid value. Do you have a current Vacation policy? -None- Yes No Please provide a valid value. Current Vacation Policy Details Please provide a valid value. Do you have any other policy we need to be aware of? -None- Yes No Please provide a valid value. Other Policy Details Please provide a valid value. Do you have Workers Compensation Insurance? -None- Yes No Please provide a valid value. What do you use? -None- Monthly Prem. Pay-Go Carrier Please provide a valid value. Workers Compensation Carrier Please provide a valid value. Do you have disability insurance? -None- Yes No Disability Insurance Details Do you offer Health insurance? -None- Yes No Health Insurance Details Do you currently track ACA? -None- Yes No ACA Details Departments Information Please list your department titles and give us room to add in details regarding those departments? Please provide a valid value. MISC Information Who is your current payroll provider? Please provide a valid value. Current Payroll Login Information & Password ? *by submitting this information you give PPS permission to access your account. Please provide a valid value. CPA Information CPA Name Please provide a valid value. CPA Firm Please provide a valid value. CPA Phone Please provide a valid value. CPA Email Please provide a valid value. Do you want your CPA to have access to your information? Brokers Information Insurance Broker Name Please provide a valid value. Insurance Broker Phone Please provide a valid value. Insurance Broker Email Please provide a valid value. Health Care Broker Name Please provide a valid value. Health Care Broker Phone Please provide a valid value. Health Care Broker Email Please provide a valid value. Additional Details Let us know if there is any additional information you need us to know: Please provide a valid value. Choose the Salesperson you want to work with: Vinny Pappalardo Gabriel Krengel Please select a valid value. Attachments The following Documents are required: Employee Information. This can be a spreadsheet containing: Social Security Number Name (First, Last, MI) Full Address Date of Birth Tax Filing Status / Number of exemptions Employee Id #’s (or we can assign #s for you) Male or Female Department / Position and corresponding wage rates If employees are going to utilize Direct Deposit then they will need to supply a copy of a voided check and completed Direct Deposit form Voided Business Check SS4 Form Please upload your documents here: You can upload a maximum of three files at a time. File(s) size limit is 20MB. If more than 3 attachments, please email , your sales person. Please provide a valid value. Reload Enter the Captcha: Please provide a valid value. Submit
