Payroll Services for Bank Customers

To refer a customer to the Paychex Payroll program, please complete the form below.

All fields are required unless specified otherwise.

Bank and Referring Employee Information

Select a Bank

Employee First Name

Employee Last Name

Employee ID

Employee Phone

Employee Email

Branch Name

Branch Number

Branch ZIP

SurePayroll Employee Name

Sales Rep Information

Rep First Name

Rep Last Name

Prospect Information

First Name

Last Name

Title

Phone

Company Name

Street Address

Zip/Postal Code

Number of Employees

Additional Information

Comments