New Client Company FormSignature Back Office Solutions2025-04-17T14:10:36+00:00

New Client Company Form

Recruiting Firm(Required)

Client Legal Name(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Payment Terms(Required)

A/P Name(Required)

First Name Last Name

A/P Phone Number(Required)

A/P Email Address(Required)

Purchase Order Number (if applicable)

Business Description(Required)

PLACEMENT PROFILE

W.C. Class Code

State Work Performed(Required)

Start Date(Required)

Number of Placements(Required)

Length of Assignments(Required)

Pay Rate(Required)

Bill Rate(Required)

Position Description(Required)

Include an attachment

Max. file size: 10 MB.

Submitted By *(Required)

First Name Last Name

Work Email(Required)

Submitted Date(Required)

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