Request Quote
Gold's Gym Franchise
REQUEST FOR PEO PROPOSAL Date: _____________________
Name of Prospect: _____________________ Federal Tax I.D.# ______________________
Address: ________________________ Contact Person: ____________________________
City, State, Zip: _________________________ Phone #: _________________________
Description of Operations: ______________________________________________________
____________________________________________________________________________
Do you want to include employee benefits in proposal? Yes No
(Please attach data for current health plans being offered)
Years in business: _____ Number of Employees: _____ Annual Payroll: _____
W/C Code: ________ Employees: ______ Job Duties: ____________________
W/C Code: ________ Employees: ______ Job Duties: ____________________
W/C Code: ________ Employees: ______ Job Duties: ____________________
Current Workers Comp Carrier: _____________ Currently with PEO: Yes No
Prospect’s W/C modifier: __________ Prospect’s SUTA: ___________
Attach copy of current w/c declaration page or leasing company billing report if possible.
Comments: _________________________________________________________
____________________________________________________________________
PLEASE FAX THIS PAGE BACK TO (512) 291-9830, or email to ron@peosales.com