NetPay Intake Form

NetPay, LLC Client Intake Form & Terms of Services

Business Name

Business Address

Federal EIN

City State ZIP

Primary Contact Name

Contact Phone

State Withholding Account Number

Contact Email

example@example.com

How did you hear about us

State Unemployment Account Number

Number of Employees

Number of Contractors

Type of Services Needed

Preferred Start Date

Date

If "Applied For" items are not submitted by the client within the onboarding period, a $50 fee will be assessed until received.

Current Payroll Provider if any

1.The client agrees to provide all required documentation including a voided check, EIN, and tax forms prior to

2.A one-time onboarding/set-up fee of $40 is due before processing begins and is non-refundable. This fee covers:

Secure submission to our 3rd d-party payroll provider

Please note: If the payroll provider declines onboarding due to compliance or security issues, this fee is non- refundable as it covers time and services already rendered. 3. Failure to comply with federal or state verification requirements may result in termination of onboarding or

4.NetPay LLC is not responsible for missed filings or penalties due to late, incomplete, or inaccurate information

provided by the client. 5.The client will receive a secure link to complete additional onboarding steps electronically. This must be completed before services begin. 6. If the onboarding process is not completed within 7 business days due to client inaction, the file will be closed. Reactivation will require a new setup fee. 7. By signing below, the client agrees to these terms and understands the responsibilities of both parties.

Client Signature

Date

Printed Name

Title