Request a Proposal & Quote
REQUEST FOR PEO PROPOSAL Date: _____________________
Name of Prospect: _______________________________
Federal Tax I.D.# _________________________________
Address: _______________________________________
Contact Person: __________________________________
City, State, Zip: ________________________________
Phone #: ________________________________________
Description of Operations: _______________________________________________________________
_______________________________________________________________
_______________________________________________________________
Do you want to include employee benefits in proposal? Yes No
(Please attach data for current health plans being offered)
Years in business: _____ Number of Employees: _____
Annual Payroll: _________
W/C Code: ________ Employees: ______ Job Duties: ____________________
W/C Code: ________ Employees: ______ Job Duties: ____________________
W/C Code: ________ Employees: ______ Job Duties: ________________
Current Workers Comp Carrier: _____________
Currently with PEO: Yes No Prospect’s W/C modifier: __________
Prospect’s SUTA: ___________ Attach copy of current w/c declaration page or leasing company billing report if possible. Comments: _________________________________________________________________
____________________________________________________________
PLEASE FAX THIS PAGE BACK TO (512) 291-9830
Name of Prospect: _______________________________
Federal Tax I.D.# _________________________________
Address: _______________________________________
Contact Person: __________________________________
City, State, Zip: ________________________________
Phone #: ________________________________________
Description of Operations: _______________________________________________________________
_______________________________________________________________
_______________________________________________________________
Do you want to include employee benefits in proposal? Yes No
(Please attach data for current health plans being offered)
Years in business: _____ Number of Employees: _____
Annual Payroll: _________
W/C Code: ________ Employees: ______ Job Duties: ____________________
W/C Code: ________ Employees: ______ Job Duties: ____________________
W/C Code: ________ Employees: ______ Job Duties: ________________
Current Workers Comp Carrier: _____________
Currently with PEO: Yes No Prospect’s W/C modifier: __________
Prospect’s SUTA: ___________ Attach copy of current w/c declaration page or leasing company billing report if possible. Comments: _________________________________________________________________
____________________________________________________________
PLEASE FAX THIS PAGE BACK TO (512) 291-9830