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Payroll USA, Inc.

(Optional Workers Comp and/ or General Liability)

Company Legal Name*

Contact Name (First Name)*

Last Name*

Phone Number

Email to Receive Quote (We Do Not Send Spam Emails!!)*

Zip Code*

# of Employees*

Pay Frequency*

Current Payroll Method*

How Did You Hear About Us?

Gross Weekly Payroll

Include Pay As You Go Workers Comp Quote*

Yes

Include General Liability Insurance Quote*

Yes

Additional Comments

Free Text

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Main Phone: (941) 756-1700

Fax: (941) 727-1039

Employee Leasing #GM309 Florida DBPR