Information You'll Need
Accurate PEO pricing depends on creating the most complete picture of your business. In addition to completing the Pricing Request form there are a few more pieces of information you'll want to locate. more>>
Pricing Your Way
Don't feel like filling out a form? No problem! Call ACI today and begin pricing over the phone in just minutes. more>>
You have questions, we have answers.
It helps to get the facts about how a PEO can help your business and services makes sense. A PEO salesman may not always be able to provide the most accurate objective advice. more >>
Corporate Office
2061 Englewood Rd.
Suite 1A
Englewood, FL 34223
Toll Free: +1 877 473 8858
Fax: +1 941 473 3111
 

Take a moment to complete our Pricing Request below in order to obtain rates from leading PEO's who specialize in your industry and region. Be sure to indicate special requirements or needs of your business. If you would prefer to print and fax this form, click here.

To obtain basic pricing For the most accurate pricing you'll need to provide a few more pieces of information. Click here to see additional information you'll need.

After submitting your Pricing Request an ACI Consultant will contact you promptly to discuss PEO rate options and answer any questions you may have.
 
Company Information  
Name of Business
Doing Business As
 Fed Tax ID or Taxpayer ID
Years in Business 
Form of Business
Contact Name
Contact Title
Mailing Address
City
State
Zip
Telephone Number 
Fax Number
Web site
E-mail Address
Yes, add me to ACI mailing list
   

Describe your Business:
 
Current Number of Full Time Employees
Current Number of Part Time Employees
Your current State Unemployment Tax Rate
Payroll Cycle
Estimated gross payroll per pay cycle
Do you currently use a PEO? Yes No
Do you currently use a payroll service? Yes No
Name of PEO or Payroll Company
Do you currently carry Workers' Comp. Insurance? Yes No
Have you had any Workers' Comp claims in the past 3 years? Yes No  
   
Workers' Compensation Class Codes  
State

Class Code or Job Type
Full Time Employees
Part Time Employees
Annual Payroll
   
PEO Underwriting  
Do you use any subcontractors? Yes No
If you do use subcontractors, what percentage of the work is subcontracted?
Do you have operations in other states?     Yes No
Have you been cited for any OSHA violations in the last three years? Yes No
Does your company engage in work other than that described above? Yes No
   
Please explain all "yes" answers
   
What services are most important to you?  
Check all that apply  
Health Insurance Benefits Workers' Comp. Insurance
Payroll Administration Time Savings
Human Resources Support Lower Administrative Costs
Risk Management & Compliance Internet-Based Reporting
Employee Benefits Client Service and Support
Staffing Services Employee Assessment Tools
Human Resources Consulting Employee Training
Banking and Lending Financial Planning Services
Accounting and Business Planning Retirement Benefits
   
When is the best time to reach you?
How did you hear about ACI?
When do you anticipate making a decision?
Agent ID
   
Additional Comments  
 
I have read the following statement
 
By submitting this form, I agree that all information is accurate and complete to the best of my knowledge and authorize Assessment Center, Inc. (ACI) to submit this information to its partners in order to obtain current pricing from Professional Employer Organizations (PEOs). I understand that I will not be held responsible for payment of any fees to ACI and that I am in no way obligated to any additional activity. I further understand that ACI is a broker and not a PEO, that they do not provide PEO services and that they do not make any guarantees as to the solvency, capability or performance of any PEO.