Quick Evaluation Form

 

* Organization:

 

* Contact Person

 

* Title

 

* Telephone Number

 

  Fax

 

* Email

 

* Address

 

* City

 

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* Zip Code

 

* Pay State Unemployment Taxes Pay Your Own Claims

 

* Current Unemployment Tax Rate

 

* Number of Employees Full Time

 

  Number of Employees Part Time

 

* Total Gross Annual Payroll (For Last Year)

 

* Total SUI Taxable Payroll (For Last Year)

 

Total Amount ($) of Unemployment Benefits Paid for:

 

* 2010

 

* 2009

 

* 2008