Request Form

Request Form
Former Employees: Your 2017 W-2 was mailed to your address on file. If you have moved since leaving QuickChek Corporation, please update your address using the form below. QuickChek Corporation will not email your W-2 forms to you. Please allow up to 10 business days for your request to be processed.
Current Team Members: You can access your W-2 forms on QC Express.
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Year requested

201720162015201420132012
Year requested

20172016
New address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Full name*

First NameLast Name
Last 4 digits of your Social Security Number*
Birth year*
Email address
QuickChek Corporation cannot and will not email copies of your W-2 forms.
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Agreement and Terms

I hereby authorize QuickChek Corporation to release a copy of my W-2 form to the mailing address indicated above. I understand that the information I provided above are accurate and correct. QuickChek Corporation will not mail my W-2 forms if the information I provided fail to match the authentication requirements.
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Agreement and Terms