Employee Information Update Form

Employee W2 Reprint Request Form

Please fill out your information below. Please ensure you fill out all fields, as required.
Personal Information
Name *

First Name Middle Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number *

Area Code Phone Number
E-mail *
Birth Date *

Month Day Year
Employee ID
Last four digits of Social Security Number or Tax ID *
I confirm that, to the best of my knowledge, this information is correct and true, and that I am requesting a reprint of my W-2. By signing this document electronically, I agree that my electronic signature is the legal equivalent of signing this document in writing.

Clear
Reason for requesting W-2 reprint *

Wrong address on file Correct Address on file, did not receive in mail Lost W-2
W-2 Reprint *

Mail to Address listed above. Due to COVID-19, we are not allowing W-2 pick-up at this time, for everyone's safety.
Should be Empty:

Employee W2 Reprint Request Form