COMPANY PAYROLL INFORMATION SHEET
(price starting at $150/mos, up to 5 employees or contractors)
Company Name:
*
Company EIN:
*
Company Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Primary Officer Name:
*
First Name
Last Name
Primary Officer Title:
*
Social Security Number:
*
Date of Birth:
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address:
*
example@example.com
DOR Withholding Number:
*
UI Account #:
*
UI Rate:
*
Company Bank Name:
*
Routing Number:
*
Account Number:
*
Business Owner Must Provide:
DRIVERS LICENSE
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SOCIAL SECURITY CARD
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ACH AUTHORIZATION FORM (void check, bank statement, confirmation letter)
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DOR WITHHOLDING
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UI ACCOUNT NUMER & UI RATE IS ONLY REQUIRED IF YOU HAVE W2 EMPLOYEES (IF YOU ONLY HAVEINDEPENDENT CONTRACTORS, PLEASE MARK N/A IN THAT SECTION).
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Submit
Should be Empty: