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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:  _________________________________________________________________
____________________________________________________________ 

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