Interested in DMR payroll services?

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Fax

(###)

###

####

Payroll Contact Name *

First Name

Last Name

Payroll Contact Phone *

(###)

###

####

Pay Period Start Date

MM

DD

YYYY

Pay Period End Date

MM

DD

YYYY

Pay Date

MM

DD

YYYY

Deductions

Select all that apply

401K/Retirement

Health Insurance

125 Cafeteria Plan

Personal Use of Company Vehicle

Do You Offer Direct Deposit?

Yes

No

Do You Offer Paycards?

Yes

No

Do You Have Company Check Stock?

Yes

No

Do You Offer Commissions/Bonuses?

Yes

No