The Nonprofit Unemployment Fund - Quick Evaluation Form

* Organization:

* Contact Person

* Title

* Telephone Number

Fax

* Email

* Address

* City

* State

* 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:

* 2009 $

* 2008 $

* 2007 $