Radcliffe Payroll Services New Client Set Up

Company Information
Date:	*
Federal ID #:	*
Legal Name:	*
DBA Name:
Legal Address:	*
City:	*
State:	*
Zip:	*
New Business:	Yes  |  No
Business Type:	Sole Proprietor  |  Partnership
	C. Corp  |  S. Corp.
Check Information
Name on Check:	*
Check Address - Same as Legal?	Yes - skip to Payroll Contact Information  No - fill out below address fields*
Payroll Delivery Address:
City:
State:
Zip:
Phone:
Fax:
Payroll Contact Information
Payroll Contact:	*
Title:
Phone:	*
Fax:
Email:	*
Owner Information
Owner Name:	*
Phone:	*
Fax:
Email:	*
CPA Information
CPA Name:
Address:
City:
State:
Zip:
Phone:
Fax:
Email:
	Send Duplicate Payroll to CPA
Payroll Information
Date of First Check:	*
Payroll Submission Method:	Please Select One Call-In Fax Online E-mail *
Payroll Frequency:	Please Select One 52 - Weekly 26 - Bi-Weekly 24 - Semi Monthly 12 - Monthly *
Period Ending Day:	*
Payday:	*
Input Day:	*
Note: There must be a 48-hour	window between payroll input day and pay day
Delivery Method:	Please Select One Online Retrieval E-mail UPS Standard UPS Next Day USPS Regular Mail USPS Priority Mail Pick Up Courier *
Number of Employees:	*
Federal Tax Frequency:	Please Select One Semi-Weekly Monthly Quarterly *
Check Here for Employees in Multiple States:	Our representatives will contact you for more information
Primary Withholding State:	*
State ID Number:	*
State Withholding Tax Frequency:	Please Select One Semi-Weekly Monthly Quarterly *
Check Here for Locations in Multiple States:	Our representatives will contact you for more information
Primary Unemployment State:	*
State ID Number:	*
State Tax Rate:	*
Check Here for Divisions:	Our representatives will contact you for more information
Check Here for Departments:	Our representatives will contact you for more information
Paper Timesheet (if applicable)
Skip Page by Department:	Yes  |  No
Skip Page by Division:	Yes  |  No
Print Rates on T/S:	Yes  |  No
Print Salaries on T/S:	Yes  |  No
Print Rates on Checks:	Yes  |  No
Earnings (Check All That Apply)*
Regular  Over-Time  Other  Salary  Commissions  Special Time  Vacation  Sick  Personal  Holiday  Tips  Mileage Reimbursement
Other:
Deductions (Check All That Apply)*
Miscellaneous  Advance  Other  Store Charge  Phone  Loan  Health - Pre Tax  Health - Post Tax  Dental - Pre Tax  Dental - Post Tax  Life - Pre Tax  Life - Post Tax  SIMPLE IRA  401(k)  Other Retirement Plan
Other:
Bank Information (Payroll Account)
Bank Transit (9 Digits) #:	*
Checking Account #:	*
Start Payroll with Check #:	*
Optional Services (Check All That Apply)
Retirement Plan Check Creation and/or Submission  Garnishment Checks  3rd Party Agency Checks  Employment Screening  Pay View  EasyChoice HR Answerlink  Encore Online  Direct Deposit  Time and Attendance System  Certified Payroll  GL  Worker's Compensation through the Hartford
Other:
Preauthorization of Transfer of Funds: * Clicking Below Constitutes an Electronic Signature
Direct Deposits:	*
EFT For Fees:	*
Tax Impound & Filing:	*
Net Pay Impound:	*
Name:	*
Title:	*
Date:	*
I have read the terms and conditions on the AGREEMENT FOR SERVICES,* and I authorize Radcliffe Payroll Services to process payrolls for the above company, under the terms and conditions on the agreement for services document.
Reporting Agent Authorization Form 8655 Please Download, Print and Fax Above Form to 410.778.7988 Attn: Payroll
*we’ll be respectful of your data, but this is a required field