Please provide some basic information on your company so we can accurately determine your package price point.

Address:

Phone:

E-mail:

State:

City:

Zip Code

Please describe the nature of your business below:

Interested in ESG’s services because _____.

We have ____ full time employees.

___ Workers’ Comp claims last year.

We have ___ employee turn over.

Company:

Name:

ESGManagement, Inc. DBA Employer Services Group    

1860 Eastman Ave. Suite 107     Ventura, CA      93003

Phone: (805) 642-9590     Fax:  (805) 642-9519     Email: info@employerservice.net

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November 17, 2008

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