New Client Leasing Census

Company Information

Business Address
Business Address
NOTE:  If you have more than one business location, please put additional locations in the "Other Information" field located at the bottom of the page.
Company Status
Company Type

Owner/Officer Information

please list the main contact owner first.

Other Authorized Contacts

Payroll Data

Leasing all Employees
Payroll Frequency
Accrued Time Tracking
please indicate how you compute accrued time for each type checked off.

Payment and Delivery

Prepayment Requirement:  We require all payroll exposure to be covered by guaranteed funds before we will release your payroll.  If you plan to set up automatic drafts from your account to pay for invoices (this is the typical choice), then a prepayment is required to remain on hand with us.  This can be paid up front with guaranteed funds, or we can bill this prepayment over 5 installments, but you will need to pay with guaranteed funds until the full amount is established.
I have read and understand the Prepayment Requirement
Method of Payment
If you are paying by Wire Transfer we will only release payroll once the wire has been received.
If you select Automatic Draft, please provide your bank name, the bank routing number, your account number and account type.
this will be 9 digits
Payroll Delivery Options

Workers Compensation Coverage

Do you currently have a Workers Compensation policy?
please list the codes on your policy, or attach a copy of the Workers Compensation Classification Page (upload button below). Codes appear formatted like: "8810" and will have estimated wages listed alongside.

Other Information

Employee Census

Please complete this schedule for each employee or you may upload a payroll register using the upload feature (below) or in a separate email.
Initials can also be used.
worked per week
per the classifcation schedule
or title

Maximum file size: 268.44MB


Full Name