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Enrollment

    Company Name (DBA)
    Legal Filing Name
    Street Address
    City
    State
    Zip Code
    Owner Name
    Email Address
    Phone Number
    Fax Number
    Name of Contacts Authorized to Discuss Payroll
    Federal Employer ID Number
    EDD State ID Number
    Principle Business Activity

    Payroll Information

    Approximate Number of Employees

    Are you interested in using Direct Deposit?

    YesNo

    Would you prefer to have your checks pre-signed?
    YesNo
    Pay Frequency
    WeeklyBiweeklySemiMonthlyMonthly
    Date you would like to receive your first payroll
    Starting check number to be printed on your payroll checks

    Tax Information

    Please specify your tax payment frequency SemiWeeklyMonthly
    Special Instructions