Payroll Information
This information will allow us to direct deposit your pay weekly
Employee Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State
Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Social Security Number
*
Date od Birth
*
/
Month
/
Day
Year
Date
Marital Status:
*
Single
Married
Divorced
Other
Number of Dependents (under age 17)
*
Number of Other Dependents:)
*
Would you like to be a...
*
W2 Employee
1099 Indepenmdent Contractor
Bank Information
For Direct Deposit
Bank Name
*
Account Type
*
Checking
Savings
9 Digit Routing Number
*
Account Number
*
Submit
Should be Empty: