Enrollment

Section 1. Company Information
Company Legal Name:
DBA Name:
Entity Type:
Phone:
Fax:
Web Address:
Address:
City: St: Zip:
Company Principal Name:
Company Principal Email:
Web enrollment completed by name:
Title of person completing web enrollment:
Completed by Email:
Section 2: Conversion Information
Business status:
Which service/software are you converting from?
If 'Other Software/Provider' please specify:
Date of your last payroll with this provider? MM/DD/YYYY 
Have you paid wages this year ?
Will your first payroll be the first payroll of the quarter?
Section 3: Payroll Processing Options
Payroll Frequency:
Cut third-party payment checks (i.e. Child Support, Garnishment, etc.) ($3.50/ea)
Create G/L Import File (Additional fees will apply):
Multiple Divisions :
Department Allocation :
Job Costing/Labor Allocation :
Section 4: Payroll Schedule
When Pay Day is on a Weekend or Holiday:
1st Check Date: MM/DD/YYYY
1st Check is for pay period ending: MM/DD/YYYY
1st Check Pay Data will be sent by: MM/DD/YYYY
2nd Check Date: MM/DD/YYYY
2nd Check is for pay period ending: MM/DD/YYYY
List all e-mail addresses that should receive electronic payroll reports:
Section 5: Delivery Options
Do you want your checks sealed (requires electronic check signature)?
How do you want your checks/vouchers delivered?
Publish my pay stubs/W2 Forms to the internet so that my employees can view their check stubs
Section 6: Accountant Information
Accounting Firm Name:
Phone:
Fax:
Accountant Mailing Address:
Who is your main contact at the accounting firm?
Accountants Email Address:
Would you like us to Email your payroll reports to your accountant?:
Section 7: Payroll Checking Account Information   ( Privacy & Security Statement )
Bank Name:
Bank Account Number:
Bank Routing Number:
Starting Sequence Number for Payroll Checks:
Section 8: Tax Information
Federal Tax Information:
FEIN-Include Dash:
FUTA Exempt:
Federal Tax Deposit Frequency:
If you use a 3rd-Party Sick Pay provider, who is responsible for W-2 generation?:
State Tax Information:
State Withholding Tax Identification Number:
State Withholding Tax State:
State Withholding Deposit Frequency:
State Unemployment Identification Number:
State Unemployment Rate:
SUTA Exempt:
If Corp Officer Exclusion List Exempt Officers:
We have employees WORKING in more than one state:
Section 9: Workers Compensation Information
Current Workers Compensation Insurance Carrier:
Policy Expiration Date: MM/DD/YYYY
(This information is used to verify auditors' information requests.) 
Section 10: Earnings
Regular Hourly Earnings: Holiday:
Overtime (1.5 * Reg Rate): Holiday (1.5 * Reg Rate):
Salary: Personal:
Sick: Vacation Earnings:
Commission: Bonus:
Personal Use Company Vehicle: Cash Tips:
Auto Reimbursement: Credit Card Tips:
Group Term Life: Sub-S Corp. 2% Owner Health Ins:
List earnings (if any), EXEMPT from 401K matching formula: Additional Custom Earnings:
Section 11: Deductions

Sec 125 (Pre-tax) Medical: STD Insurance (Pre-Tax):
Sec 125 (Pre-tax) Dental: STD Insurance (Post-Tax): 
Sec 125 (Pre-Tax) Flex Plan: LTD Insurance (Pre-Tax):
Sec 125 (Pre-Tax) Dependent Care: LTD Insurance (Post-Tax):
Sec 125 (Pre-tax) Vision: Medical Insurance (Post-Tax):
HSA (Pre-Tax): Employee Advance:
HSA (Post-Tax): Child Support:


Additional Custom Deductions:
You MUST fax copies of all current child support and garnishment orders. Remit to 888-381-5521, Attn: Enrollment Team
Retirement Plan:
If you have a retirement plan, please describe EXACTLY the method used to calculate your EMPLOYER MATCH component.
Section 12: Benefits Tracking (Check all that apply)
Vacation Benefits : PTO :
Sick Benefits :
Section 13: Enrollment Questions
Section 14: Additional Services Information Request (check the box of all services that you would like to learn more about)
Online Human Resource Management Time and Labor Management(Wall mount)
Workers Comp:   Pay-As-You-Go 
Employee Services for AppExchange
QuickBooks General Ledger Export



Submit Form