Payroll Services Agreement Module Step 1 of 3 33% Select Type of ServicesStart My Payroll ServicesOrder Check (first time)Reorder Checks Personal InformationName* First Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Date of Birth*Social Security Number*Phone Number*Email* Business InformationBusiness Name*Business E.I.N*Have you previously had payroll services?*NoYesBusiness VEC Account NumberVA Dept of Taxation Account Number*Business Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code START UP FEE (one time) Price: Current Number of Employees*Please enter a number from 1 to 100.Pay Period Frequency*WeeklyBi-WeeklyPayroll Starting Date* MM slash DD slash YYYY Select Payroll Package*1 - 4 Employees | $37.00 per pay period10-15 Employees | $70.00 per pay period20-30 Employees | $89.50 per pay period40-50 Employees | $108.00 per pay period$3 per employee not included in package.Employee Payroll Set-Up* Order Payroll Checks Direct Deposit Check Order*100 checks | $57.95250 checks | $105.95500 checks | $325.95Check Order (one time fee)*100 checks | $57.95250 checks | $105.95500 checks | $325.95Upload Company's Voided Check*Max. file size: 100 MB.Total $0.00 Personalization of Checks spCheck Starting Number sspCheck Color (sp) American (patriot) Blue Burgundy Brown Green Red Yellow Line 1 (on check) spLine 2 (on check) spLine 3 (on check) spLine 4 (on check) spLine 5: an extra line (optional) spSelect Logo Option sp No Logo Upload Logo Upload Company's Logo spMax. file size: 100 MB.Personalization of ChecksCheck Starting Number (sp)Check Color American (patriot) Blue Burgundy Brown Green Red Yellow Line 1 (on check)Line 2 (on check)Line 3 (on check)Line 4 (on check)Line 5: an extra line (optional)Select Logo Option No Logo Upload Logo FileMax. file size: 100 MB.Bank Account InformationName of Bank*Account Number*Routing Number*Disclosure | Agreement Section1. Preparing Payroll. Information received will be consider confidential. Client should submit payroll information no later than Tuesday’s at 12:00 noon. Checks will be issued to employees no later than Friday morning. All deductions & appropriate taxes will be remitted. Client will receive a secure online dashboard where they can submit payroll & review all reports as well as all additional paperwork for payroll.* I agree 2. Compensation. All payments are automatically drafted from your company’s debit or credit card, on the agreed due date. As a courtesy, BF will send out invoices on Mondays as a payment reminder. All payments will be drafted from business account on Fridays at 9:00AM. All payments received after 5:00 pm will receive a $25.00 late fee.* I agree 3. No Refund Policy. Brinkley Financial LLC has a strict no refund policy on service purchased & upon the signing of any agreements.* I agree 4. Corrections. BF LLC shall be responsible only to the extent of correcting any errors which are the fault of BF LLC. BF LLC shall not be liable for errors that were not caught by the Client on the processing in which they first occurred.* I agree 5. Cancellation: This subscription may be cancelled by either, BF LLC or client, provided that a written notice is given to the client 30 days (one full month) in advance; via email or fax. Client has the right to terminate this contract immediately if a payment that covers one full month is submitted in place of the 30 day notice (paid UPFRONT in one lump sum payment). If the Client has an unpaid balance, the amount of the unpaid balance must be added on top of the final payment to satisfy the contract. All financial documents will be released only upon collecting final payment.* I agree Authorization: I authorize the terms mention in the above. I certify that the information provided herein is true and complete in all respects, and that I have read and understand, consent, and agree to all the terms and conditions of Brinkley Financial LLC payroll systems.* I agree FINAL TOTAL $0.00 Payment SectionName on Card* First Last Card Number*CVV Number (3 numbers on back)*Expiration Date*FINAL TOTAL $0.00 CAPTCHA
