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5133 S FM 549

Rockwall, TX, 75032


www.trendsetterhr.com
(214) 553-5505 (Ph), (469) 402-0248 (Fax)
HR Services Request for Quote
Thank you for your interest in requesting a quote for services from Trendsetter HR. In order to get your
quote started, please fill out as much information as possible below and fax this form to 469-402-0248.
Please note: Additional information beyond that requested here may be required to provide an accurate quote for services.

Contact Name ___________________________________________________


Contact Email ___________________________________________________
Contact Title ___________________________________________________

Contact Phone ____________________ Contact Fax _________________


(Trend Use Only)
Date ____________________ Reference # _________________

Referral Name ___________________________________________________

Company Name ___________________________________________________


Company Website ___________________________________________________
Company Address ___________________________________________________
Company City ___________________________________________________
State _____________________ Zip Code _________________

Owner Name ___________________________________________________


Business Phone _____________________ Business Fax _________________

Copyright © 2010, Trendsetter HR Services 1


Services of Interest
Workers Comp Coverage
Payroll & Tax Administration
Medical & Dental Coverage
Life Insurance Coverage
Safety & Risk Consulting
Human Resource Consulting
Employee Management

Fed Tax ID _______________ Years in Business _________________


Nature of Business ___________________________________________________

___________________________________________________

___________________________________________________

___________________________________________________

___________________________________________________

___________________________________________________
Business Locations List all company locations

__________________________________________________

__________________________________________________

__________________________________________________

__________________________________________________

__________________________________________________

__________________________________________________

Copyright © 2010, TrendsetterHR Services 2


Operating Entities If you have multiple operating entities, list each one here

__________________________________________________

__________________________________________________

__________________________________________________

__________________________________________________

__________________________________________________

__________________________________________________

__________________________________________________

__________________________________________________

__________________________________________________
Number of FTE’s Number of full time employees
________________________
Number of part time employees
________________________

Texas SUTA Rate ___________________________________________________


Payroll Frequency
Weekly
Bi-Weekly
Monthly
Semi-Monthly

Pay Period Begins __________________________________________________


st
For example, “Monday” or “1 day of the Month”

Pay Period Ends __________________________________________________


For example, “Sunday” or “Last day of the Month”

Copyright © 2010, TrendsetterHR Services 3


Pay Date __________________________________________________
th
For example, “Friday” or “15 and Last Day of the Month”

Employee WC Class State Code Position / Job # Emps


(Enter the number of
EE’s for each class _________ ________ ____________________ _________
code in the company)
_________ ________ ____________________ _________

_________ ________ ____________________ _________

_________ ________ ____________________ _________

_________ ________ ____________________ _________

_________ ________ ____________________ _________


WC Deductible ___________________________________________________
Current WC deductible

WC Policy Renewal
Date ___________________________________________________
Date client company WC policy renews

Health Deductible ___________________________________________________


Current health deductible

Health Copay ___________________________________________________


Current health plan copay

Health Renewal Date ___________________________________________________


Current health plan copay

Copyright © 2010, TrendsetterHR Services 4


Check if any of the Current Safety Manual (If they have a safety manual and/ or written
documents below is safety policy)
provided
Background Check Policy (If they conduct pre/post employment
background checks on new hires for high hazard jobs, a copy of the
program or policy

Recent Health / Ins. Bills (If there is a documentation of recent health


and/ or supplemental insurance bills)

Employee Census (A copy of health insurance census showing


employees and dependents)

Your Name (Person


Filling Out Form) ___________________________________________________
Your Signature ___________________________________________________

Please fax this entire form to our PEO Sales fax-to-email number:

469-402-0248

Copyright © 2010, TrendsetterHR Services 5