All Information is Confidential

Your Name	(Required)
Title
Company Name
Address
City
State
Zip
Phone	(Required)
Fax
E-mail	(Required)
Preferred Contact:	Phone Fax E-mail US mail
Is this a New Business? :	Yes No

Your Payroll

Number of Employees	(Required)
Pay Frequency	Weekly Biweekly Semi-monthly Monthly
Current Payroll Vender
Out-of-state reports?	Yes No
If yes, what states?

Optional Services
Electronic Reports (.pdf format)	Direct Deposit of Employee Checks
Laser Signature on Checks	Checks in Sealed Envelopes
Online HR Resource Center	Worker's Compensation Insurance
Online Submission of Payroll Data	Web G/L- Integrate Checkmate generated payroll data with you Quickbooks interface via a simple file download
How did you hear about Checkmate ?