banks.adpinfo.comReferral Form

All Referral leads must be faxed to 877-219-8144 in order to ensure proper credit for you and your Bank . Once faxed, you should also share this Referral with your assigned ADP District Manager. -- Please complete the information requested below and click submit. If this is an urgent request, you should also share this with your assigned ADP District Manager. REFERRAL INFORMATION: * Company Name: Date: * Address: Tax ID: -- * City: State: Select One AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY * Zip: * Contact First Name: * Contact Last Name: Title: * Phone: E-mail: Frequency of Payroll: Select One W=Weekly B=Bi-Weekly S=Semi Monthly M=Monthly O=Other No. of Employees: Current Payroll Method: Select One 1=Manual 2=Software 3=CPA 4=SVC Bureau 5=Leasing 6=Other Contact banker prior to sales call: Yes No * Required BANK ASSOCIATE INFORMATION: Banker Email Employee Name: Phone: Branch Name: Branch No.: Do not put zeros in front of Branch No. Cost Center: Region No.: District No.: Banker ID: Business Line: Comments: (maximum 250 characters) Referrals are delivered to ADP District Managers within 24-48 hours from the date the lead form is submitted on-line. If this is an urgent request, please contact your ADP District Manager directly after submitting this form. Privacy and Security | Legal...