Master Contract

Company Proposal Form
Company Owner's Full Name*

First NameLast Name
Company Owner's Contact Number*
Please enter a valid phone number.
Company Owner's Email Address*
example@example.com
Please select the best way(s) to contact you:*

PhoneEmailText Message
Legal Business Name*
Date of Incorporation*

MonthDayYear
Employer Entity Type*

C CorpS Corp (Taxed as S pass thru, partnership, or sole proprietor)S Corp (Taxed as C Corp)LLC (Taxed as S Corp pass thru, partnership, or sole proprietor)LLC (Taxed as C Corp)LLPPartnershipSole ProprietorshipNot-For-ProfitGovernment AgencyChurch or Religious AffiliateOther
Do you currently have a Section 125 Cafeteria Plan implemented in your company?*

YesNo
Employer's State Of Organization*
Human Resources Representative's Full Name*

First NameLast Name
Human Resources Representative's Contact Number*
Please enter a valid phone number.
Human Resources Representative's Email Address*
example@example.com
Employer Fiscal Year End*

Calendar YearOther
Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business EIN / Tax ID Number*
How many full-time W2 employees do you currently employ?*
How often are your employees paid?*

12 - Monthly24 - Semi-Monthly26 - Bi-Weekly52 - Weekly
Who is your payroll provider?*
When do you run payroll?*
Example: "the 1st and 15th" or "every Friday"

Please list all of the owners of the company and their percentages of ownership:*

Do you offer your employees major medical coverage?*

YesNo
Do you pay a portion of your employee's health benefits?*

YesNo
Please select the benefits provided by the employer (Select ALL that apply):*

WellnessMedicalDentalVisionCancerCritical IllnessHospital IndemnityLifeAccidentShort-Term DisabilityLong-Term DisabilityI.R.C. Code Section 125 PlanFlexible Spending AccountDependent CareHRAHSAOtherNone
Please upload a current payroll census/payroll report in Excel Spreadsheet with the following fields:Name, Annual Gross Income (estimated for hourly employees) Birthdate, State of Residence, Marital Status, W4 dependents/deductions, Pay Frequency, phone number, address, email, current medical insurance benefits status.(Please mark consistent seasonal employees if you have them). Please remove social security numbers.*

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Company Proposal Form