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Lawlerts

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New Client Setup update form Affiliate

Affiliate Representative:

First Last

Affiliate Company Name:(Required)

Representative Email:

Representative Phone:

Office Address

Street Address City State / Province / Region ZIP / Postal Code

Affiliate Billing Contact Name:

First Last

Affiliate Billing Contact Email:

Client Company Name:(Required)

union shop

Union Shop

Billing Address

Street Address City State / Province / Region ZIP / Postal Code

Primary Contact Name:(Required)

First Last

Primary Contact Email(Required)

Primary Contact Phone

Client Billing Contact Name

First Last

Client Billing Contact Email:

Type Of Industry:

Client Office Locations

Add Additional Location 1?

Yes

No

Location 1 Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

# of Employees at Location

Is location 1 within a 75-milie radius of another location?

Yes

No

Add Additional Location 2?

Yes

No

Location 2 Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

# of Employees at Location

Is location 2 within a 75-milie radius of another location?

Yes

No

Add Additional Location 3?

Yes

No

Location 3 Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

# of Employees at Location

Is location 3 within a 75-milie radius of another location?

Yes

No

Add Additional Location 4?

Yes

No

Location 4 Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

# of Employees at Location

Is location 4 within a 75-milie radius of another location?

Yes

No

Add Additional Location 5?

Yes

No

Location 5 Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

# of Employees at Location

Is location 5 within a 75-milie radius of another location?

Yes

No

Special Instructions for Setting Up This Account

Authorized Representative Name(Required)

Authorized Representative Signature:(Required)

Signature Date

MM slash DD slash YYYY

Guardian HR provides human resources and employment law support services to companies nationwide. We've provided unlimited first-class service to employers from small businesses to multi-nationals since 2004.

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Email

(888) 373-4724 sales@guardianhr.com

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