Professional Employer Organization Limited Registration Form

 
 

To the ALABAMA DEPARTMENT OF LABOR :

     The undersigned, a professional employer organization subject to the provisions of the Alabama Professional Employer Organization Registration Act, as last amended, hereby registers for the privilege of operating as a limited professional employer organization in the State of Alabama, and submits the following facts under oath to the Alabama Department of Labor:
     
 
 

 
Professional Employer Organization Information:
Tell us more about your PEO:
Name of PEO
  Please enter the full name of the PEO.

Date of Organization:

   
Please enter date as mm/dd/yyyy.

Unemployment Compensation Account #

   
Please only numbers. No hyphens.

Federal ID #:

   
Please only numbers. No hyphens.

Business Address:

 
Please enter the address were the PEO is located.

City:

 
Please enter the city in which the PEO is located.

State:

Please enter the state in which the PEO is located.

Zip

   
Please enter a five digit zip code.

Telephone

   
Please enter the telephone number as
( XXX) XXX-XXXX.

Fax

 
Please enter the Fax number as
( XXX) XXX-XXXX.

Web site:

 
Please enter as "www.mywebpage.com".