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Please Note: A Professional Employer Organization (PEO) is a cost-effective solution to managing many “Employee Administration” related functions for your company. By acting as a “Co-Employer” of your workforce, a PEO allows you to outsource time consuming and costly employer responsibilities while focusing on your core business!

Please take a few minutes to complete the form below. The information provided will help us provide you with a "no cost" and "no obligation" PEO Services Proposal. Any information provided us will be utilized for the exclusive purpose of procuring a proposal for your consideration. We take your privacy very seriously! Please review our confidentiality agreement for more information.

Our Online PEO Proposal Request Process is:

     • Fast
     • Easy
     • Confidential
     • No Cost
     • No Obligation

This simple process can easily provide “Relief” from your Business Headaches!


1. Please enter your contact information.
* Company: 
* Contact Name: 
* Address: 
 
* City: 
* State: 
* Zip: 
* Phone: 
* Fax: 
* Email: 
* Company Website: 

2. Company Overview:
* Number of years in business: 
* Number of active employees (Full and part time): 
* Approximate annual payroll for Company: 
* Payroll Frequency (i.e. weekly, bi-weekly, semi monthly, etc…): 

3. Additional Company Information:
Company’s Federal Identification Number (9 digits): 
Primary Workers’ Comp Class Codes: 
Current State Unemployment Insurance Rate: 
Current Workers’ Comp Experience Modifier: 
Approximate number of unemployment claims last 24 months: 
Approximate number of workers’ comp claims last 24 months: 

4. What PEO Services or Benefits are you interested in receiving?
No Workers’ Comp Deposits or Audits. 
Payroll and Employment Tax Administration
Workers’ Comp Coverage
Employee Benefits
Regulatory Compliance
Human Resources Support
Unemployment Claims Administration
Risk Management/ Safety Support

>5. How does your Company currently manage the following?
Payroll Administration:   PEO  Payroll Service  In-House  Other
Benefit Administration:   PEO  In-House  Other
Unemployment Claims:   PEO  In-House  Other
Work Comp Claims:   PEO  In-House  Other
Personnel Issues:   PEO  In-House  Other

6. What Employee Benefit Programs are you interested in or considering?
Group Health Plan
Limited or Mini Medical Plan
401K Plan
Vision and/or Dental Plan
Flexible Spending Plan
Supplemental Insurance Products (LTD, STD, Cancer, Life, etc…)
Other:

7. When would you like to start receiving PEO Services for your company?
ASAP!
Less than One Month from now.
Within One to Two Months.
More than Two Months from now.

8. How did you discover the LL Roberts Group?
Internet Search (Google, Yahoo, etc…).
Newspaper, Radio, or Magazine Advertisement.
Letter, Fax or Email Introduction.
Sales Agent. If so, whom
Referral. If so, whom

9. Please note any additional comments or questions you may have concerning your interest in a PEO relationship or proposal:


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