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Your Name:      Company Name:

Company Address:  City: State:  Zip:

Phone Number:        Company Website:

E-Mail Address:  Your Title:

Best Day & Time to Contact:     Number of Employees:  

Pay Frequency: Please choose one Weekly Bi-Weekly Semi-Monthly Monthly Quarterly Annually       Would you like Direst Deposit: Please Answer Yes Maybe Interested Not Interested

Report Delivery Options: Please Answer E-Mail UPS Ground US Postal Service Remote Client Access    How did you Hear About Us?

Paycheck / DD Advise Delivery Options: Please Answer E-Mail Remote Client Access UPS Ground US Postal Service To Me US Postal Service To EE's Direct

Payroll Services Type you would like Quoted: Please Answer Full Service After The Fact Tax Service Software as a Service (SaaS)

Software as a Service (SaaS)  & Support Options: Please Choose One Payroll Processing & Tax Software Human Resources Info System (HRIS) Time & Attendance Software ACH Direct Deposit Processing Software Not Interested In Any

Looking for any other type of services: Please Answer Back Office & Write-Up Accounting Services Personal & Business Income Tax Preparation Insurance Sales & Support Not Interested In Any Other Services

Current Payroll Processing Service Provider: Please Choose One ADP Paychex Payroll One Your Accountant You do it yourself Other   For How Long:

What would convince your to Hire Partners In Payroll? Please Answer Price Simple Reports Paydate Journal Entry One-on-one Service Deal with Smaller / Local Company Other