Impact HR Solutions

First name*

Last name*

Address Line 1*

Address Line 2*

City*

State*
Alabama Alaska Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

ZIP*

Phone*

Email address*

Industry type* (select):
Agriculture, Forestry, Fishing Construction Finance, Insurance, Real Estate Manufacturing Not For Profit Other Public Administration Retail Trade Services Transportation Wholesale Trade

Are you currently doing your own (check all that apply):

Benefits administration	Compliance administration	Human resources administration	Payroll administration
Safety and risk management	Workers' compensation

How long have you been in business?

How many employees do you have?

What industry or industries is your business engaged in?

What state or states does your business operate in?

Have you used or are you currently using a PEO service?

Comments

How did you hear about us?:

Advertisement	Association	Insurance Agent	Other
Referred	SOI Rep	Trade Show	Web