Discovery of Needs

1 Company Overview

2 Payroll & Technology Solutions

3 Human Resources

4 Risk Solutions

5 Employee Benefits

6 Wrap Up

Please provide the following information
Legal Name*
Phone Number*
Address*
Street Address Address Line 2 City State ZIP Code
State of Incorporation*
Your company's Federal Employer Identification Number (FEIN)
Brief description of your company's operations*
Please provide the following information for your company's main contact
Name*
First Last
Phone Number
Email*
Are there additional entities, with employees, that are associated with the parent company?*
- Yes
- No
Additional Entities
Please provide the following information on your second additional entity
Legal Name*
Address*
Street Address Address Line 2 City State ZIP Code
State of Incorporation*
Do you have other additional entities, if so how many total?
Please enter a value greater than or equal to 0.
Company Overview continued
How many full time employees does your company employ?*
How many part time employees does your company employ?
How many office locations do you have?

Employee Benefits
Are you interested in offering your employees medical benefits?*
- Yes
- No
Employee Benefits continued
What is the waiting period for new hires to enroll in benefits?*
What is the employer contribution towards benefits?*
What is the effective date with your current carrier?*
MM
DD
YYYY
Do you offer a 401K retirement plan?*
- Yes
- No
Are you interested in a PEO’s 401K plan if there was no cost to you?*
- Yes
- No

	Not important	Somewhat important	Important	Very important
Human Resource Support
Scalability / Business Growth
Compliance Guidance
Compliant Payroll Tax Strategy and Filing
Improved Benefits Offering
Worker's Compensation Insurance
Access to Risk Management Team for Worker's Compensation Issues or Claims

Please provide the following information