New Client Questionnaire

Questionnaire Web Form

Services

Payroll

Time and Attendance

Onboarding

Benefit Admin

ACA

LMS

Hire

Please select at least one service.

Basic Information

Company Legal Name *

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DBA

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What Company Name should be printed on the Check?

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Company Phone

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Company Fax

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Company Website

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Business Description

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NASIC Code

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Business Address Information

Business Legal Address

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Business Legal City

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Business Legal State

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Business Legal Zip Code

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Mailing Address Same as Legal Address

Which address would you like the checks/reports sent to?

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Mailing Address

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Mailing City

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Mailing State

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Mailing Zip Code

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Corporate Officer Information

Corporate Officer First Name *

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Corporate Officer Last Name *

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Phone

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Email *

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Preferred Method of Contact:

Phone

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Authorized Contacts Information

Contact 1 Name

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Contact 1 Phone

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Contact 1 Email

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Contact 1 Responsibilities

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Is Contact 1 an Owner?

Do you want this contact to have access to reporting/portal access?

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Contact 2 Name

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Contact 2 Phone

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Contact 2 Email

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Contact 2 Responsibilities

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Is Contact 2 an Owner?

Do you want this contact to have access to reporting/portal access?

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Business Identification Information

FEIN Number

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State ER If different from FEIN

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Additional State Registration & Number

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Status Unemployment Insurance Information

Is Company registered for SUI?

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SUI Number

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SUI Rate (%)

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Bank Account Information

Need voided check from Payroll Account

Bank Name

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Routing Number

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Account Number

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Starting Check Number Something that will never coincide with any manual checks you may write.

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Do you want all fees pulled from main Account?

Do you want your signature to be printed on all live checks?

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Is Company processing entries on behalf of another Third-Party Sender?

IF Yes, Explain

Does Company use foreign funds for either settlement or receipt of payroll

Check Format?

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What account are physical checks drawn on?

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Benefits & Deductions Information

Deductions

Child Support

Wage Garnishments

401K IRA

Medical

Is there a 401k?

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If yes, Provide more 401k Details

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Do you have a current PTO policy?

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Current PTO Policy Details

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Do you have a current Sick policy?

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Current Sick Policy Details

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Do you have a current Vacation policy?

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Current Vacation Policy Details

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Do you have any other policy we need to be aware of?

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Other Policy Details

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Do you have Workers Compensation Insurance?

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What do you use?

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Workers Compensation Carrier

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Do you have disability insurance?

Disability Insurance Details

Do you offer Health insurance?

Health Insurance Details

Do you currently track ACA?

ACA Details

Departments Information

Please list your department titles and give us room to add in details regarding those departments?

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MISC Information

Who is your current payroll provider?

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Current Payroll Login Information & Password ?

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CPA Information

CPA Name

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CPA Firm

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CPA Phone

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CPA Email

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Do you want your CPA to have access to your information?

Brokers Information

Insurance Broker Name

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Insurance Broker Phone

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Insurance Broker Email

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Health Care Broker Name

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Health Care Broker Phone

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Health Care Broker Email

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Additional Details

Let us know if there is any additional information you need us to know:

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Choose the Salesperson you want to work with:

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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.

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