Establishment Name:
Person In Charge:
Your Title:
Your email address:
Your phone number:
Your fax number:
# of Years in
Operation:
# of employees:
Payroll Dates:
(i.e. 1st & 15th ...)
Billing Address
Street - Line 1:
Billing Address
Street - Line 2:
Billing Address City:
Billing Address
Zip Code:
Billing Address State:
Shipping Address
Street - Line 1:
Shipping Address
Street - Line 2:
Shipping Address City:
Shipping Address
Zip Code:
Shipping Address State:
Accounts Payable
Contact:
Acc't. Paybl. Phone #:
Business Bank:
Bank Contact:
Bank phone number:
Comments and/or
Special Instructions:
Thank you for completing Server Station's Payroll
Deduction Plan New Account Application!  
We will be contacting you very shortly and look forward
to a great business relationship with you!  
Welcome to Our
Payroll Deduction Plan
New Account Application!

Please fill this form out and submit it so we
can get you all set up right away!  
Customer service will contact you once you
are set up in our system (usually within 1
business day!) or if we have any questions.
 Then your staff may start purchasing
everything they need online immediately!  

Please be advised that by submitting this
application, you (the establishment)
assumes all responsibility for purchases
made using your payroll deduction
account.  In the event that a staff member
makes a purchase greater than their
corresponding paycheck, the
establishment is responsible for payment in
full at that pay period....you deal directly
with your staff...we deal directly with you!
Click to verify BBB accreditation and to see a BBB report.
Click to verify BBB accreditation and to see a BBB report.