TrendHR – a Professional Employer Organization (PEO)

Request for a Quote

Company Name

Address Line 1

City

State

Zip

Owner Name		Title
Contact Person		Title

Services Of Interest to you

Federal Tax Number	Union Affiliation	Yes No
Business Number	Fax
E-Mail Address	Years in Business

Type of Business

Additional Business Location? If so where?

State Unemployment Tax Rate in Texas		Other States
Number of Full Time Employees		Part Time
Payroll Frequency	Weekly Biweekly Monthly

Describe Operations (including all Worksites)

Does your Company have Multiple Operating Entities?

Yes No

List Name and Type of entity

Workers Compensation Wage Information
State	WC Class Code	Position/Job	#Employees	Annual Wage

Do you have a safety manual and written safety policy? (If yes, attach a copy)	Yes No
Do you conduct pre/post employment background checks on new hires for high hazard jobs? (If yes, attach a copy of the program or policy)	Yes No
If available, please attach documentation of recent health and / or supplemental insurance bills	Please Browse to Attach File.
If available, please attach a health insurance census showing employees and dependents	Please Browse to Attach File.

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