Employers Pay-Care Services, Inc.
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Request a Free Quote

To request a quote by phone call us Toll Free in Florida at 800-790-9273

To enable PayCare to develop a customized quote for your business, just complete the following request form and hit "Submit".  We will contact you with a response by either phone or email (whichever you prefer).  

* = required field
Company & contact information:

*Company Name
*Address
Address (cont.)
*City
*State

* Zip

*Contact Name
Title
*Work Phone () -
*FAX () -
E-mail
URL

Would you prefer to be contacted by:
E-mail
Phone

Give us a quick description of your business.
# of Employees                             Years in Business   

Tell us about your payroll and workers' compensation breakdown:

To form an accurate quote, we have to break down your employees into Workers' Compensation class codes.  If you know your 4 digit class code (example: Clerical employees = 8810) then enter that number below with the corresponding number of employees and approximate weekly gross wages.  If you don't know the comp. class code, just give us a job title

Workers' compensation Experience Modification Rate:

Job Performed # Employees Comp Code Annual Payroll Rate Per $100
$ $
$ $
$ $
$ $
$ $
# of Comp Claims Last Year $ Value of Claims $

Unemployment and PEO History:

Current State Unemployment Tax Rate: 
# of Unemployment Claims Last Year: 
Current PEO Admin Fee:

 How did you hear about PayCare?                       

 


Copyright © 2004 [Employers Pay-Care Services, Inc.]. All rights reserved.
Revised: January 06, 2006