PEO Quote Form

PEO Quote Form
  • Initial Submission Documentation
  • Company Name / EIN #*
  • Entity Type Sole Proprietor/ LLC/ S Corp*
  • Years in business*full name here
  • Number Employees Full time / Part time*full name here
  • Description of business*further details
  • Company Address*full name here
  • Website*full name here
  • Phone #*full name here
  • Fax #*full name here
  • Any other locations? / States/ # of locations*full name here
  • List of Work Comp Codes being used*full name here
  • SIC or Industry code*full name here
  • Union shop? Y/N*full name here
  • Current W/comp carrier*full name here
  • Other benefits offered Health/ Vision/ Dental/ Life/ etc.*full name here
  • Projected staff growth or reduction this year? %?*full name here
  • #W'2s Issued last year*full name here
  • 1099's last year?*full name here
  • Current yr $ projected annual Payroll*full name here
  • Health carrier/ plan type PPO/HMO/ High Deductible ?*full name here
  • Payroll cycle ? weekly? bi-weekly? Any commission / Incentive Pay?*full name here
  • Current State % Unemployment Insurance Rate?*full name here
  • Workers Compensation Mod Rate ?*full name here
  • Do you offer Direct Deposit?*full name here
  • Do you have any certified H.R. Staff? Handbook?*full name here
  • Do you have a formal Safety Program/ Manual/ committee?*full name here
  • Do you do Documented new hire orientation?*full name here
  • background screening ? Y/ N*full name here
  • Do you have a probationary period?*full name here
  • Have you done anything to comply with the Affordable Care Act?*full name here
  • Anchor HR PEO
    1-888-879-6981 fax
    1-618-969-0053 Cell
    Underwriting@anchorhrpeo.com