EMPLOYER ONLINE REQUEST FOR UCAC's 
NO-COST, NO-OBLIGATION UC COST ANALYSIS AND PROPOSAL FOR COST REDUCTION

Company Name  

Street Address  

City  

State  

Zip Code  

Current Number  
      of Employees  

Name of Person Inquiring

Title

Phone

Email

Fax

Please state areas of particular concern and/or interest:

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A UCAC Account Representative will respond to this application and will explain the technical data required for this free analysis and comparison of your company’s current unemployment compensation tax liability.