Let's Get Some Quotes! Section 1 of 3
Primary Email Address
We'll use this to send you quotes and updates.
Company Name
Confirm the legal name of your business.
Your Name
Your name as the primary contact.
Website
Your company's primary website URL.
Full Address
Street address, city, state, and ZIP code.
What is the EIN of your company?
If you have multiple EINs, use the one running payroll and filing payroll taxes — this is the EIN the PEO will contract with.
What is your role within the organization?
Your title or position at the company.
Total number of employees
Include all full-time and part-time employees.
Which states do you have employees in? Optional
List state abbreviations separated by commas.
Which payroll or PEO provider do you currently use? Optional
Leave blank if you don't currently use one.
What is your payroll frequency?
How often do you run payroll?
When would your first pay period on the new PEO start?
This is known as the Effective Date in PEO terminology.
Do you want to get a quote for Medical / Dental / Vision / Ancillaries?
Select whether you'd like benefits quotes as part of this process.
Current health carrier(s)
Name the insurance carrier(s) you currently use for health coverage.
When do your benefits renew?
The date your current health plan renews each year.
Have you received your benefits renewal for this year?
Let us know if you've already seen your renewal documents.
Upload your renewal document Optional
Upload all pages of your benefits renewal document if you have it.
📄 Click to upload or drag and drop PDF, DOC, or image files accepted
How many years have you been with your current carrier?
Enter the number of years you've been with your current health insurance provider.
Is your current plan self-funded?
Self-funded (self-insured) plans mean your company pays claims directly rather than paying premiums to a carrier.
Is your COBRA population greater than 10% of your total covered employees and dependents?
Count all individuals on COBRA vs. your total covered population.
Do you know of employees with any notable health conditions? Optional
Check any that apply based on your knowledge. Under no circumstances should you ask employees to provide this information.
Do you have anyone currently on medical leave?
Include employees on FMLA or any other medical leave of absence.
Upload a census for employees and dependents Optional
Include fields such as name, date of birth, relationship, and zip code for employees and dependents.
📋 Click to upload your census file Excel, CSV, or PDF accepted
Upload Summary of Benefits Coverage documents Optional
These are the SBC documents provided by your current carrier for each plan offered.
📑 Click to upload SBC documents PDF files preferred
Upload your most recent medical invoice with enrollment detail Optional
This helps us understand your current enrollment numbers and premium costs.
🧾 Click to upload your medical invoice PDF or image files accepted
Do you want to include Worker's Compensation Insurance in your PEO quote?
Workers' comp coverage can often be bundled at a better rate through a PEO arrangement.
Is there a drug free program in place?
A formal drug-free workplace program may qualify you for premium discounts in some states.
Have there been any OSHA issues in the last 5 years?
Include any OSHA inspections, citations, fines, or violations.
In the last 5 years have you had your WC coverage denied, non-renewed or cancelled?
This includes voluntary market cancellations or being placed in a state assigned risk pool.
Is work performed underground or higher than 15 ft in the air?
This includes excavation, mining, roofing, high-rise construction, or elevated platform work.
Do operations include trucking?
Include any long-haul, regional, or local delivery operations using commercial vehicles.
Any exposure to nuclear materials or toxic chemicals?
Include any work involving hazardous substances, radioactive materials, or regulated chemicals.
Are company vehicles used?
Include any vehicles owned, leased, or regularly used by employees for business purposes.
Are temporary or seasonal employees used?
Include any workers hired through staffing agencies or on a short-term/seasonal basis.
Is any voluntary or donated labor used in regular operations?
Include volunteers, interns, or other unpaid workers who regularly participate in business operations.
As a regular part of their job, do any employees travel outside the country?
Include any routine international travel for business purposes, excluding occasional trips.
Do employees work for other businesses or subsidiaries?
Include any shared employee arrangements or workers who split time across affiliated entities.
Do employees mostly work from home?
Indicate if the majority of your workforce is remote or hybrid on a regular basis.
Are physicals required after offers of employment are made?
Pre-employment physicals are common in safety-sensitive roles and may affect your WC classification.
Is any work performed on barges, vessels, docks, bridges or under, on or over water?
Marine or waterfront work may require special coverage under maritime law.
Is any work subject to the Jones Act, USL&H or FELA?
These federal statutes govern maritime workers, harbor workers, and railroad employees respectively.
Have there been any fatalities in the last 5 years?
Include any work-related deaths, regardless of fault or whether a claim was filed.
Do independent or subcontractors make up more than 20% of your workforce?
Count all 1099 contractors and subcontractors relative to your total working population.
Any work sublet without Certificates of Insurance (COIs)?
Subcontractors without COIs may create uninsured liability exposure for your business.
Does the company own, operate or lease aircraft/watercraft as part of their job?
Include any planes, helicopters, boats, or personal watercraft used for business operations.
Please upload your full policy, 3 years of loss runs (5 if your premium is over $100k/yr), and your most recent payroll register with class codes. Optional
These documents help carriers accurately assess your risk profile and provide the most competitive quote.
📂 Click to upload your WC documents PDF, DOC, Excel, or image files accepted
Any employment related litigation, investigations or state/federal charges pending or in the last 5 years?
Include any EEOC charges, lawsuits, or regulatory investigations involving employment matters.
Is the company aware of pending or threatened claims against it or its owners?
Include any informal complaints, demand letters, or known disputes that could escalate.
Any planned or prior (in the past 3 years) plant, location or office closings?
Include any layoffs, reductions in force, or facility closures within the past 3 years or planned in the near future.
Any union employees?
Indicate whether any portion of your workforce is covered by a collective bargaining agreement.
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