ACCURACY + SERVICE + VALUE

P A Y R O L LbackP L U S


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Your name :..........Best time to call... am pm anytime (Pick one)

Company

Address : City : State : ZIP :

Phone : FAX : e-mail :

What services are you currently receiving from your payroll provider ?
-------- 401k Cafateria Plan (125 Plan)
-------- Data entry using your computer Get reports on the internet
-------- Direct Deposit Check signing
-------- Full tax service EFTPS
-------- Workers comp through payroll Multipule State Payroll

What services are you interested in receiving from PAYROLL PLUS ?
-------- 401k Cafeteria Plan (125 Plan)
-------- Data entry using your computer Get reports on the internet
-------- Direct Deposit Check signing
-------- Full tax service EFTPS
-------- Workers comp through payroll Multipule State Payroll

How often do you pay your employees?
How many emplyees do you have at any one time?
What payroll service are you currently using?
-------- A D P
-------- Paychex
-------- Ceridian
-------- Accountant
-------- In House
-------- Haven't needed Payroll service before

Please use the space below to give us any information about your needs that will help us respond:
---------------------THANK YOU for your interest in PAYROLL PLUS

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