Free Employee Leasing Analysis

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We are able to produce a free preliminary employee leasing analysis of your business provided we have the following information. After you submit the information, a representative will review your information and contact you. (NOTE: We do not share any information with any 3rd parties, all information submitted to us is confidential.)

Business Name
Address
City, State, Zip
Phone
Fax
Email
Type of Business
Years in Business
Contact

I. Current Payroll Information

1. Pay Cycle	(i.e. bi-weekly, weekly, semi-monthly)
2. Payroll for 1 pay period
3. # of Employees	F/T P/T

II. Health Insurance Information

1. Type of Plan & Carrier		(i.e. PPO, HMO, Idemnity)

2. Plan Description
	A. Deductible
	B. Maternity	Yes	No
	C. Dental	Yes	No
	D. Life	Yes	No
	E. Prescription Card	Yes	No

3. Health Insurance Renewal Date

4. Company Contribution to Health Benefits

PROFESSIONAL EMPLOYER RESOURCES
500 N. MAITLAND AVENUE, SUITE 201 MAITLAND, FLORIDA 32751
(407) 599-4990 (888) 599-4991
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