ENTERPRISE HR

AND AFFILIATES

EMPLOYEE PAYROLL/NEW HIRE DATA

Company Name ________________________________________________________ Client # _____________________________

EMPLOYEE DATA

Employee Name ___________________________________________ Male Female

Social Security Number ____________________________

Date of Birth ______/_______/_______ Married Single

US Citizen: YES NO If No, Alien Registration # _________________________ Expiration Date _____/_____/_____

Address_____________________________________________________ Suite/Unit ____________

City ______________________State _______Zip___________ Phone Number _________________ Email _______________________

Emergency Contact: _____________________________________________________

Previous Employers (Last 5 Years)

Include a State W/H election form if applicable for the state in which you work.

THIS SECTION TO BE COMPLETED BY EMPLOYER

Occupation Category: Officials & Managers Professionals Technicians Sales Workers Office Clerical

Operatives (semi-skilled) Laborers (unskilled) Service Workers

Pay Type: Hourly Salary Commission Tips Other _______________________

Work Status: Full-Time Part-Time Hours per pay period ______________________

Pay Period: Weekly Bi-Weekly Semi-Monthly

Wage and Hour Exempt: YES NO

Rate of Pay: $__________________________ Hire Date: ______________________________

Department ___________________________ Workers’ Compensation Code ________________________________

Client Signature: ____________________________________________________ Date: _______________________________

700 Central Ave, STE 500, St. Petersburg, FL 33701 • (727) 520-7676 • (888) 770-7676 • Fax (727) 525-8156
 ENTERPRISE HR
AND AFFILIATES

TERMS AND CONDITIONS OF EMPLOYMENT

I, the undersigned employee, acknowledge by my signature that I have been informed that I am a leased employee of Enterprise HR, Enterprise HR II, Encore Business
Solutions, Encore PEO, Enterprise III, or Primecore Inc., (hereinafter referred to as “AFFILIATES”), leased to _________________________________________________
(“Client”). I understand and agree that this agreement may be assigned by Enterprise HR and affiliates at its sole discretion to any licensed employee leasing company as
listed with Florida’s Department of Business and Professional Regulation. I further understand and agree that either my employer or I can terminate our employment
relationship at any time, as I am an at will employee. I also understand and agree that if Enterprise HR and affiliates does not receive payment from the client for services
which I perform as a leased employee, Enterprise HR and affiliates will pay me the current minimum wage (and/or the legally required overtime wages, if applicable) for any
such pay period. I also agree that if at any time during my employment I am subjected to any type of discrimination, including discrimination because of race, sex, age,
religion, color, national origin, disability, or marital status, or if I am subjected to any type of harassment, including sexual harassment, I will immediately contact Enterprise
HR and affiliates’ Human Resource Manager at (888) 770-7676 or the on-site supervisor of the leased client in order to obtain assistance in the resolution of such matters. I
understand that I am on probation as an employee for the first 90 days of my employment that started on ________________________________ for the purposes of the
Florida Unemployment Compensation Law. I understand that at the time Enterprise HR and affiliates receives notification from the leased client that I have been either
dismissed or reassigned, Enterprise HR and affiliates will mail to my address of record a notice of termination. Upon receipt of this notice I understand that I have 72 hours
to call Enterprise HR and affiliates for reassignment. Failure to do so may result in a denial of unemployment benefits.

DRUG-FREE WORKPLACE POLICY NOTICE TO APPLICANT:

It is the policy of Enterprise HR and affiliates, that all employees are prohibited from the unlawful manufacture, distribution, dispensation, possession, or use of any
controlled substances, including alcohol, in the workplace and remote job sites. Drug and alcohol testing will occur after every job related injury. All benefits will be denied
if tests are positive. Testing will occur on a random basis and if there is reasonable suspicion. The following drugs will be tested for according to company policy: alcohol,
cocaine, depressants, marijuana/cannabis, narcotics and stimulants. Any employee violating this policy may be subject to immediate discharge. The signature below is
acknowledgment that I have read and understood Enterprise HR and affiliates’ drug-free workplace policy. I understand as a condition of my employment I may be asked to
voluntarily submit to a pre-employment drug test and I agree to follow, without reservation, the drug-free workplace policy.

WORKERS’ COMPENSATION REQUIREMENTS:

I agree to immediately report all on-the-job injuries to my supervisor. I also agree to post-accident drug and alcohol testing within 24 hours of my injury, where permitted by
law. I will comply with all medical treatment authorization regulations and managed care plans as applicable under state law. If the treatment situation is an emergency I
understand I can initially be treated at any emergency treatment facility or call 911. I understand that Enterprise HR and affiliates will have my claim assigned to an insurance
adjuster who will assist me and authorize any additional treatment. I acknowledge that it may be a criminal felony to file a false workers’ compensation claim.

SAFETY REQUIREMENTS:
I agree to follow all company safety policies and to use/wear all employer-supplied personal protective equipment, such as but not limited to: safety glasses, gloves, goggles,
hard hats, harnesses, tie-offs, steel-toed boots, masks, respirators, etc. I agree to operate all machinery in accordance with the manufacturer’s safety standards and will not
remove any safety guards or alter the machinery. I agree to report any unsafe conditions, defective equipment or machinery I observe/use to my supervisor immediately. I
acknowledge that if I refuse to wear safety equipment or obey safety rules that I may be subject to termination and possible reduction in workers’ compensation benefits as
defined by law.

ASSISTANCE:
If I have any questions that my worksite employer cannot answer regarding workers’ compensation, safety policy, unsafe working conditions, equipment or machinery, I
acknowledge I can contact Enterprise HR and affiliates’ Risk Management Department for assistance.

CERTIFICATION AND AGREEMENT

I certify the answers given herein are true and complete to the best of my knowledge. I authorize investigation of statements contained
herein as may be necessary. I understand that false or misleading statements may result in termination of employment. If hired, I
understand my employment is probationary for a period of 90 days.

By signing this document, I acknowledge that I have read (or had read to me), and fully understand all conditions of employment and job safety rules.

Employee Name (printed)_________________________________________________________________________________________________________________

Employee Signature______________________________________________________________________________________________________________________

700 Central Ave, STE 500, St. Petersburg, FL 33701 • (727) 520-7676 • (888) 770-7676 • Fax (727) 525-8156
Form W-4 Employee’s Withholding Certificate
Complete Form W-4 so that your employer can withhold the correct federal income tax from your pay.
OMB No. 1545-0074

Department of the Treasury

Internal Revenue Service
Give Form W-4 to your employer.
Your withholding is subject to review by the IRS.
2023
(a) First name and middle initial Last name (b) Social security number
Step 1:
Enter Address Does your name match the
Personal name on your social security
card? If not, to ensure you get
Information City or town, state, and ZIP code credit for your earnings,
contact SSA at 800-772-1213
or go to www.ssa.gov.
(c) Single or Married filing separately
Married filing jointly or Qualifying surviving spouse
Head of household (Check only if you’re unmarried and pay more than half the costs of keeping up a home for yourself and a qualifying individual.)

Complete Steps 2–4 ONLY if they apply to you; otherwise, skip to Step 5. See page 2 for more information on each step, who can
claim exemption from withholding, other details, and privacy.

Step 2: Complete this step if you (1) hold more than one job at a time, or (2) are married filing jointly and your spouse
Multiple Jobs also works. The correct amount of withholding depends on income earned from all of these jobs.
or Spouse Do only one of the following.
Works (a) Reserved for future use.
(b) Use the Multiple Jobs Worksheet on page 3 and enter the result in Step 4(c) below; or
(c) If there are only two jobs total, you may check this box. Do the same on Form W-4 for the other job. This
option is generally more accurate than (b) if pay at the lower paying job is more than half of the pay at the
higher paying job. Otherwise, (b) is more accurate . . . . . . . . . . . . . . . . . .

TIP: If you have self-employment income, see page 2.

Complete Steps 3–4(b) on Form W-4 for only ONE of these jobs. Leave those steps blank for the other jobs. (Your withholding will
be most accurate if you complete Steps 3–4(b) on the Form W-4 for the highest paying job.)

Step 3: If your total income will be $200,000 or less ($400,000 or less if married filing jointly):
Claim Multiply the number of qualifying children under age 17 by $2,000 $
Dependent
Multiply the number of other dependents by $500 . . . . . $
and Other
Credits Add the amounts above for qualifying children and other dependents. You may add to
this the amount of any other credits. Enter the total here . . . . . . . . . . 3 $
Step 4 (a) Other income (not from jobs). If you want tax withheld for other income you
(optional): expect this year that won’t have withholding, enter the amount of other income here.
This may include interest, dividends, and retirement income . . . . . . . . 4(a) $
Other
Adjustments (b) Deductions. If you expect to claim deductions other than the standard deduction and
want to reduce your withholding, use the Deductions Worksheet on page 3 and enter
the result here . . . . . . . . . . . . . . . . . . . . . . . 4(b) $

(c) Extra withholding. Enter any additional tax you want withheld each pay period . . 4(c) $

Step 5: Under penalties of perjury, I declare that this certificate, to the best of my knowledge and belief, is true, correct, and complete.
Sign
Here
Employee’s signature (This form is not valid unless you sign it.) Date

Employers Employer’s name and address First date of Employer identification

Only employment number (EIN)

For Privacy Act and Paperwork Reduction Act Notice, see page 3. Cat. No. 10220Q Form W-4 (2023)
Form W-4 (2023) Page 2

General Instructions Specific Instructions

Section references are to the Internal Revenue Code. Step 1(c). Check your anticipated filing status. This will
determine the standard deduction and tax rates used to
Future Developments compute your withholding.
For the latest information about developments related to Step 2. Use this step if you (1) have more than one job at the
Form W-4, such as legislation enacted after it was published, same time, or (2) are married filing jointly and you and your
go to www.irs.gov/FormW4. spouse both work.
Purpose of Form If you (and your spouse) have a total of only two jobs, you
may check the box in option (c). The box must also be
Complete Form W-4 so that your employer can withhold the
checked on the Form W-4 for the other job. If the box is
correct federal income tax from your pay. If too little is
checked, the standard deduction and tax brackets will be
withheld, you will generally owe tax when you file your tax
cut in half for each job to calculate withholding. This option
return and may owe a penalty. If too much is withheld, you
is roughly accurate for jobs with similar pay; otherwise, more
will generally be due a refund. Complete a new Form W-4
tax than necessary may be withheld, and this extra amount
when changes to your personal or financial situation would
will be larger the greater the difference in pay is between the
change the entries on the form. For more information on
two jobs.
withholding and when you must furnish a new Form W-4,
see Pub. 505, Tax Withholding and Estimated Tax. Multiple jobs. Complete Steps 3 through 4(b) on only
Exemption from withholding. You may claim exemption
▲ ! one Form W-4. Withholding will be most accurate if
CAUTION
you do this on the Form W-4 for the highest paying job.
from withholding for 2023 if you meet both of the following
conditions: you had no federal income tax liability in 2022 Step 3. This step provides instructions for determining the
and you expect to have no federal income tax liability in amount of the child tax credit and the credit for other
2023. You had no federal income tax liability in 2022 if (1) dependents that you may be able to claim when you file your
your total tax on line 24 on your 2022 Form 1040 or 1040-SR tax return. To qualify for the child tax credit, the child must
is zero (or less than the sum of lines 27, 28, and 29), or (2) be under age 17 as of December 31, must be your
you were not required to file a return because your income dependent who generally lives with you for more than half
was below the filing threshold for your correct filing status. If the year, and must have the required social security number.
you claim exemption, you will have no income tax withheld You may be able to claim a credit for other dependents for
from your paycheck and may owe taxes and penalties when whom a child tax credit can’t be claimed, such as an older
you file your 2023 tax return. To claim exemption from child or a qualifying relative. For additional eligibility
withholding, certify that you meet both of the conditions requirements for these credits, see Pub. 501, Dependents,
above by writing “Exempt” on Form W-4 in the space below Standard Deduction, and Filing Information. You can also
Step 4(c). Then, complete Steps 1(a), 1(b), and 5. Do not include other tax credits for which you are eligible in this
complete any other steps. You will need to submit a new step, such as the foreign tax credit and the education tax
Form W-4 by February 15, 2024. credits. To do so, add an estimate of the amount for the year
to your credits for dependents and enter the total amount in
Your privacy. If you have concerns with Step 2(c), you may
Step 3. Including these credits will increase your paycheck
choose Step 2(b); if you have concerns with Step 4(a), you
and reduce the amount of any refund you may receive when
may enter an additional amount you want withheld per pay
you file your tax return.
period in Step 4(c).
Step 4 (optional).
Self-employment. Generally, you will owe both income and
self-employment taxes on any self-employment income you Step 4(a). Enter in this step the total of your other
receive separate from the wages you receive as an estimated income for the year, if any. You shouldn’t include
employee. If you want to pay income and self-employment income from any jobs or self-employment. If you complete
taxes through withholding from your wages, you should Step 4(a), you likely won’t have to make estimated tax
enter the self-employment income on Step 4(a). Then payments for that income. If you prefer to pay estimated tax
compute your self-employment tax, divide that tax by the rather than having tax on other income withheld from your
number of pay periods remaining in the year, and include paycheck, see Form 1040-ES, Estimated Tax for Individuals.
that resulting amount per pay period on Step 4(c). You can Step 4(b). Enter in this step the amount from the
also add half of the annual amount of self-employment tax to Deductions Worksheet, line 5, if you expect to claim
Step 4(b) as a deduction. To calculate self-employment tax, deductions other than the basic standard deduction on your
you generally multiply the self-employment income by 2023 tax return and want to reduce your withholding to
14.13% (this rate is a quick way to figure your self- account for these deductions. This includes both itemized
employment tax and equals the sum of the 12.4% social deductions and other deductions such as for student loan
security tax and the 2.9% Medicare tax multiplied by interest and IRAs.
0.9235). See Pub. 505 for more information, especially if the
sum of self-employment income multiplied by 0.9235 and Step 4(c). Enter in this step any additional tax you want
wages exceeds $160,200 for a given individual. withheld from your pay each pay period, including any
amounts from the Multiple Jobs Worksheet, line 4. Entering
Nonresident alien. If you’re a nonresident alien, see Notice an amount here will reduce your paycheck and will either
1392, Supplemental Form W-4 Instructions for Nonresident increase your refund or reduce any amount of tax that you
Aliens, before completing this form. owe.
Form W-4 (2023) Page 3

Step 2(b)—Multiple Jobs Worksheet (Keep for your records.)

If you choose the option in Step 2(b) on Form W-4, complete this worksheet (which calculates the total extra tax for all jobs) on only
ONE Form W-4. Withholding will be most accurate if you complete the worksheet and enter the result on the Form W-4 for the highest
paying job. To be accurate, submit a new Form W-4 for all other jobs if you have not updated your withholding since 2019.
Note: If more than one job has annual wages of more than $120,000 or there are more than three jobs, see Pub. 505 for additional
tables.
1 Two jobs. If you have two jobs or you’re married filing jointly and you and your spouse each have one
job, find the amount from the appropriate table on page 4. Using the “Higher Paying Job” row and the
“Lower Paying Job” column, find the value at the intersection of the two household salaries and enter
that value on line 1. Then, skip to line 3 . . . . . . . . . . . . . . . . . . . . . 1 $

2 Three jobs. If you and/or your spouse have three jobs at the same time, complete lines 2a, 2b, and
2c below. Otherwise, skip to line 3.
a Find the amount from the appropriate table on page 4 using the annual wages from the highest
paying job in the “Higher Paying Job” row and the annual wages for your next highest paying job
in the “Lower Paying Job” column. Find the value at the intersection of the two household salaries
and enter that value on line 2a . . . . . . . . . . . . . . . . . . . . . . . 2a $

b Add the annual wages of the two highest paying jobs from line 2a together and use the total as the
wages in the “Higher Paying Job” row and use the annual wages for your third job in the “Lower
Paying Job” column to find the amount from the appropriate table on page 4 and enter this amount
on line 2b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2b $

c Add the amounts from lines 2a and 2b and enter the result on line 2c . . . . . . . . . . 2c $

3 Enter the number of pay periods per year for the highest paying job. For example, if that job pays
weekly, enter 52; if it pays every other week, enter 26; if it pays monthly, enter 12, etc. . . . . . 3

4 Divide the annual amount on line 1 or line 2c by the number of pay periods on line 3. Enter this
amount here and in Step 4(c) of Form W-4 for the highest paying job (along with any other additional
amount you want withheld) . . . . . . . . . . . . . . . . . . . . . . . . . 4 $

Step 4(b)—Deductions Worksheet (Keep for your records.)

1 Enter an estimate of your 2023 itemized deductions (from Schedule A (Form 1040)). Such deductions
may include qualifying home mortgage interest, charitable contributions, state and local taxes (up to
$10,000), and medical expenses in excess of 7.5% of your income . . . . . . . . . . . . 1 $

{ }
• $27,700 if you’re married filing jointly or a qualifying surviving spouse
2 Enter: • $20,800 if you’re head of household . . . . . 2 $
• $13,850 if you’re single or married filing separately

3 If line 1 is greater than line 2, subtract line 2 from line 1 and enter the result here. If line 2 is greater
than line 1, enter “-0-” . . . . . . . . . . . . . . . . . . . . . . . . . . 3 $

4 Enter an estimate of your student loan interest, deductible IRA contributions, and certain other
adjustments (from Part II of Schedule 1 (Form 1040)). See Pub. 505 for more information . . . . 4 $

5 Add lines 3 and 4. Enter the result here and in Step 4(b) of Form W-4 . . . . . . . . . . . 5 $

Privacy Act and Paperwork Reduction Act Notice. We ask for the information You are not required to provide the information requested on a form that is
on this form to carry out the Internal Revenue laws of the United States. Internal subject to the Paperwork Reduction Act unless the form displays a valid OMB
Revenue Code sections 3402(f)(2) and 6109 and their regulations require you to control number. Books or records relating to a form or its instructions must be
provide this information; your employer uses it to determine your federal income retained as long as their contents may become material in the administration of
tax withholding. Failure to provide a properly completed form will result in your any Internal Revenue law. Generally, tax returns and return information are
being treated as a single person with no other entries on the form; providing confidential, as required by Code section 6103.
fraudulent information may subject you to penalties. Routine uses of this The average time and expenses required to complete and file this form will vary
information include giving it to the Department of Justice for civil and criminal depending on individual circumstances. For estimated averages, see the
litigation; to cities, states, the District of Columbia, and U.S. commonwealths and instructions for your income tax return.
territories for use in administering their tax laws; and to the Department of Health
and Human Services for use in the National Directory of New Hires. We may also If you have suggestions for making this form simpler, we would be happy to hear
disclose this information to other countries under a tax treaty, to federal and state from you. See the instructions for your income tax return.
agencies to enforce federal nontax criminal laws, or to federal law enforcement
and intelligence agencies to combat terrorism.
Form W-4 (2023) Page 4
Married Filing Jointly or Qualifying Surviving Spouse
Higher Paying Job Lower Paying Job Annual Taxable Wage & Salary
Annual Taxable $0 - $10,000 - $20,000 - $30,000 - $40,000 - $50,000 - $60,000 - $70,000 - $80,000 - $90,000 - $100,000 - $110,000 -
Wage & Salary 9,999 19,999 29,999 39,999 49,999 59,999 69,999 79,999 89,999 99,999 109,999 120,000
$0 - 9,999 $0 $0 $850 $850 $1,000 $1,020 $1,020 $1,020 $1,020 $1,020 $1,020 $1,870
$10,000 - 19,999 0 930 1,850 2,000 2,200 2,220 2,220 2,220 2,220 2,220 3,200 4,070
$20,000 - 29,999 850 1,850 2,920 3,120 3,320 3,340 3,340 3,340 3,340 4,320 5,320 6,190
$30,000 - 39,999 850 2,000 3,120 3,320 3,520 3,540 3,540 3,540 4,520 5,520 6,520 7,390
$40,000 - 49,999 1,000 2,200 3,320 3,520 3,720 3,740 3,740 4,720 5,720 6,720 7,720 8,590
$50,000 - 59,999 1,020 2,220 3,340 3,540 3,740 3,760 4,750 5,750 6,750 7,750 8,750 9,610
$60,000 - 69,999 1,020 2,220 3,340 3,540 3,740 4,750 5,750 6,750 7,750 8,750 9,750 10,610
$70,000 - 79,999 1,020 2,220 3,340 3,540 4,720 5,750 6,750 7,750 8,750 9,750 10,750 11,610
$80,000 - 99,999 1,020 2,220 4,170 5,370 6,570 7,600 8,600 9,600 10,600 11,600 12,600 13,460
$100,000 - 149,999 1,870 4,070 6,190 7,390 8,590 9,610 10,610 11,660 12,860 14,060 15,260 16,330
$150,000 - 239,999 2,040 4,440 6,760 8,160 9,560 10,780 11,980 13,180 14,380 15,580 16,780 17,850
$240,000 - 259,999 2,040 4,440 6,760 8,160 9,560 10,780 11,980 13,180 14,380 15,580 16,780 17,850
$260,000 - 279,999 2,040 4,440 6,760 8,160 9,560 10,780 11,980 13,180 14,380 15,580 16,780 18,140
$280,000 - 299,999 2,040 4,440 6,760 8,160 9,560 10,780 11,980 13,180 14,380 15,870 17,870 19,740
$300,000 - 319,999 2,040 4,440 6,760 8,160 9,560 10,780 11,980 13,470 15,470 17,470 19,470 21,340
$320,000 - 364,999 2,040 4,440 6,760 8,550 10,750 12,770 14,770 16,770 18,770 20,770 22,770 24,640
$365,000 - 524,999 2,970 6,470 9,890 12,390 14,890 17,220 19,520 21,820 24,120 26,420 28,720 30,880
$525,000 and over 3,140 6,840 10,460 13,160 15,860 18,390 20,890 23,390 25,890 28,390 30,890 33,250
Single or Married Filing Separately
Higher Paying Job Lower Paying Job Annual Taxable Wage & Salary
Annual Taxable $0 - $10,000 - $20,000 - $30,000 - $40,000 - $50,000 - $60,000 - $70,000 - $80,000 - $90,000 - $100,000 - $110,000 -
Wage & Salary 9,999 19,999 29,999 39,999 49,999 59,999 69,999 79,999 89,999 99,999 109,999 120,000
$0 - 9,999 $310 $890 $1,020 $1,020 $1,020 $1,860 $1,870 $1,870 $1,870 $1,870 $2,030 $2,040
$10,000 - 19,999 890 1,630 1,750 1,750 2,600 3,600 3,600 3,600 3,600 3,760 3,960 3,970
$20,000 - 29,999 1,020 1,750 1,880 2,720 3,720 4,720 4,730 4,730 4,890 5,090 5,290 5,300
$30,000 - 39,999 1,020 1,750 2,720 3,720 4,720 5,720 5,730 5,890 6,090 6,290 6,490 6,500
$40,000 - 59,999 1,710 3,450 4,570 5,570 6,570 7,700 7,910 8,110 8,310 8,510 8,710 8,720
$60,000 - 79,999 1,870 3,600 4,730 5,860 7,060 8,260 8,460 8,660 8,860 9,060 9,260 9,280
$80,000 - 99,999 1,870 3,730 5,060 6,260 7,460 8,660 8,860 9,060 9,260 9,460 10,430 11,240
$100,000 - 124,999 2,040 3,970 5,300 6,500 7,700 8,900 9,110 9,610 10,610 11,610 12,610 13,430
$125,000 - 149,999 2,040 3,970 5,300 6,500 7,700 9,610 10,610 11,610 12,610 13,610 14,900 16,020
$150,000 - 174,999 2,040 3,970 5,610 7,610 9,610 11,610 12,610 13,750 15,050 16,350 17,650 18,770
$175,000 - 199,999 2,720 5,450 7,580 9,580 11,580 13,870 15,180 16,480 17,780 19,080 20,380 21,490
$200,000 - 249,999 2,900 5,930 8,360 10,660 12,960 15,260 16,570 17,870 19,170 20,470 21,770 22,880
$250,000 - 399,999 2,970 6,010 8,440 10,740 13,040 15,340 16,640 17,940 19,240 20,540 21,840 22,960
$400,000 - 449,999 2,970 6,010 8,440 10,740 13,040 15,340 16,640 17,940 19,240 20,540 21,840 22,960
$450,000 and over 3,140 6,380 9,010 11,510 14,010 16,510 18,010 19,510 21,010 22,510 24,010 25,330
Head of Household
Higher Paying Job Lower Paying Job Annual Taxable Wage & Salary
Annual Taxable $0 - $10,000 - $20,000 - $30,000 - $40,000 - $50,000 - $60,000 - $70,000 - $80,000 - $90,000 - $100,000 - $110,000 -
Wage & Salary 9,999 19,999 29,999 39,999 49,999 59,999 69,999 79,999 89,999 99,999 109,999 120,000
$0 - 9,999 $0 $620 $860 $1,020 $1,020 $1,020 $1,020 $1,650 $1,870 $1,870 $1,890 $2,040
$10,000 - 19,999 620 1,630 2,060 2,220 2,220 2,220 2,850 3,850 4,070 4,090 4,290 4,440
$20,000 - 29,999 860 2,060 2,490 2,650 2,650 3,280 4,280 5,280 5,520 5,720 5,920 6,070
$30,000 - 39,999 1,020 2,220 2,650 2,810 3,440 4,440 5,440 6,460 6,880 7,080 7,280 7,430
$40,000 - 59,999 1,020 2,220 3,130 4,290 5,290 6,290 7,480 8,680 9,100 9,300 9,500 9,650
$60,000 - 79,999 1,500 3,700 5,130 6,290 7,480 8,680 9,880 11,080 11,500 11,700 11,900 12,050
$80,000 - 99,999 1,870 4,070 5,690 7,050 8,250 9,450 10,650 11,850 12,260 12,460 12,870 13,820
$100,000 - 124,999 2,040 4,440 6,070 7,430 8,630 9,830 11,030 12,230 13,190 14,190 15,190 16,150
$125,000 - 149,999 2,040 4,440 6,070 7,430 8,630 9,980 11,980 13,980 15,190 16,190 17,270 18,530
$150,000 - 174,999 2,040 4,440 6,070 7,980 9,980 11,980 13,980 15,980 17,420 18,720 20,020 21,280
$175,000 - 199,999 2,190 5,390 7,820 9,980 11,980 14,060 16,360 18,660 20,170 21,470 22,770 24,030
$200,000 - 249,999 2,720 6,190 8,920 11,380 13,680 15,980 18,280 20,580 22,090 23,390 24,690 25,950
$250,000 - 449,999 2,970 6,470 9,200 11,660 13,960 16,260 18,560 20,860 22,380 23,680 24,980 26,230
$450,000 and over 3,140 6,840 9,770 12,430 14,930 17,430 19,930 22,430 24,150 25,650 27,150 28,600
 ENTERPRISE HR
AND AFFILIATES

EMPLOYEE REQUEST FOR DIRECT DEPOSIT

How are Direct Deposits made?

Arrangements are made to have amounts electronically transferred from your payroll check into the financial institution(s) you indicate. You will know
your pay has been direct deposited because you will continue to receive a payroll check stub indicating the amounts and the account numbers in which a
direct deposit occurred. In addition, your financial institution will show the deposit on your statement .

How to Enroll for Direct Deposit:

Read and complete this form to initiate automatic direct deposit for your entire payroll check or a portion of your net pay.

When does Direct Deposit start?

Approximately two (2) weeks after your form has been received and processed by Enterprise HR and affiliates.

Remember!

 Most direct deposit items are processed using the routing number from your voided check. However, some financial institutions require a different
number for electronic transmissions. If your financial institution is a savings and loan, credit union, or you wish to deposit into a savings account,
please verify that the routing number on your deposit slip is the same number we should use for electronic transmissions.
 Financial institutions may post electronic transactions at different times. Please check with your financial institution to determine what time they
post electronic transactions before trying to access your balance.
 For the first initial payroll deposit, call your financial institution to confirm that your direct deposit (s) have been posted properly.

EMPLOYEE INFORMATION

____________________________________________________________________________________________________________
Employee Name Social Security # Client Name Client #

________________________________________________________________________________________________________________________
Street Address City State Zip Code
TYPE OF ACCOUNT DOLLAR or % or FINANCIAL INSTITUTION ACCOUNT # Routing #
Checking, Savings, REMAINDER
Credit Union

____________________ ____________________ _______________________________ _________________________ _____________________

____________________ ____________________ _______________________________ _________________________ _____________________

____________________ ____________________ _______________________________ _________________________ _____________________

I authorize deposit of my payroll check with the above financial institution(s). The financial institution(s) is/are authorized to credit deposits to the
account(s) indicated. This authority will remain in effect until I have given 30 days’ written notice of its termination or until Enterprise HR and affiliates
or my financial institution have given me notice that this direct deposit will be terminated. I understand that I must give advance notice to allow
reasonable time for my instructions to be executed. If ever an incorrect amount should be entered into my account, I direct and authorize my financial
institution and Enterprise HR and affiliates to make the appropriate adjustment. If I do not provide a voided check or back up documentation from my
bank, I take full responsibility the information I have input on the form is true and correct. If it’s incorrect, I understand there could be a delay in the
receipt of the funds for my pay. This will be corrected once the correct banking information is provided.

____________________________________________________________________________________________________________________
Signature Date
700 Central Ave., N, Suite 500, St. Petersburg, FL 33701  (727) 520-7676  (888) 770-7676  Fax (727) 525-8156