Payroll, HR, and Tax Platform Services Intake

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Full name

Business name

Email address

Phone number

Business address

Legal entity type

Jurisdictions where employees are paid

Primary payroll, HR, and tax contact name

Primary payroll, HR, and tax contact email:

Primary payroll, HR, and tax contact phone:

Workforce and Payroll Environment Profile

Number of employees

Does the business pay contractors?

Yes

Workers type

Full-time employees

Part-time employees

Contractors

Payroll frequency

Weekly

Biweekly

Semi-monthly

Monthly

Current payroll system or provider

Current HR system or process

Planned use of the Afintrix Payroll, HR, and Tax Platform

HR functions requested

Platform setup and services requested

Integration or software details

Reporting requirements

Employer Tax Profile

Federal employer identification number

State payroll-tax registration numbers

Local payroll-tax registration numbers, if applicable

Current unemployment-tax rate, if applicable

Current payroll-tax provider or software:

Required payroll-tax registrations are in place for every jurisdiction where employees are paid:

Yes

Payroll Review, Cleanup, and Data Migration

Payroll calculation review and payroll-record support required

Yes

Wage and withholding review required

Yes

Prior payroll-period correction or cleanup required

Yes

Payroll periods included in the review or cleanup

Payroll-tax filing status:

Current

Behind

Mixed

Payroll and tax concerns, reconciliation gaps, or reporting needs

Historical data migration required

Yes

Records and periods to migrate

Employer Banking, Ownership, and Funding Authorization

Business bank name used for payroll funding

Business bank account type used for payroll funding

This account is used for payroll funding and related disbursements

Yes

The person submitting this intake is authorized to approve use of this account for payroll funding and platform processing

Yes

The business will maintain accurate bank information and notify Afintrix of changes before future payroll runs

Yes

Articles of organization or incorporation

Attached

Not available

Operating agreement or equivalent organizational document

Attached

Not available

EIN confirmation document

Attached

Not available

Additional ownership or authorization documents supporting control of the business and listed bank account

Attached

Not available

Employee, HR, and Payout Information

Current employee list showing name, status, primary work state, and pay type

Attached

Not available

Recent payroll reports

Attached

Not available

Most recent payroll register

Attached

Not available

Payroll-tax reports

Attached

Not available

Benefit deduction summary:

Attached

Not available

Not applicable

Employee pay and payout instructions provided for platform setup are accurate and authorized

Yes

Compliance and Risk Context

The business has completed identity verification with its financial institution and maintains an established banking relationship

Yes

The business is subject to known sanctions, debarment, or active enforcement actions related to payroll, tax, or financial-crime matters

Yes

Current payroll-related investigations, regulatory examinations, material disputes, or notices that may affect platform setup or operations

The business will provide supporting documents for payroll, tax, banking, and control reviews when requested:

Yes

Platform and Engagement Confirmation

Authorized name

Authorized title

Signature

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Signature date

I confirm that the information provided is accurate to the best of my knowledge. I understand that this intake supports review and onboarding for Payroll, HR, and Tax Platform Services. An engagement begins only after the requested services are reviewed, scoped, and accepted.

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