Date:

Payroll Contact:

Phone:

Sole Proprietor

LLC_

Partnership

Corporation

S-Corp

Business Name:

EIN:

Business Mailing Address:

Business Phone:

Business Fax:

Business E-Mail:

Business Website:

Number of Employees:

WEIN:

For Payroll Purposes Only:

• W4 form for all employee

• I-9 form for each employee

• Voided check for each direct deposit

• Voided check of the account to pay your employees

Signature of Taxpayer:     

Signature of Spouse:     

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