Payroll Service Enrollment

	Please provide the following information for the parent that is to be our primary contact: First Name Last Name Employer Work Phone Street Address City State   Zip Code Home Phone Home Fax Work Fax E-mail Driver's License #
	Please provide the following contact information for your spouse (if applicable): First Name Last Name Employer Work Phone Fax E-mail
	Please provide the following payment information.  We use only a secured server to process your payment information. However, if you prefer, you may enter a number here of '999999999' and then call, email or fax (480-460-1200) our office with your billing information. BILLING for Annual Fee and Set-up Cardholder Name Card Number Card Type VISA MasterCard American Express Expiration:

Please provide the following information regarding your nanny:

Nanny's Wages per Week Hour Varies

If the salary schedule will vary, you must contact us by 4pm on Thursday before the pay day.

Other compensation:
Mileage/Gas allowance
Gratuity
Meals
Other

Total of Parent's Payment = (Wages + 10%) + Other Compensation

First Payroll Date (Friday following the end of the work week)

	You need to fax or mail a W-2, I-9 and AZ Withholding statement to arrive in our office by noon on the Thursday before your nanny's first payroll.  If you need these forms you can download them from our site. Go to Download.
	Any other information that we should know in order to better process your application.