Amendment Request Form
Internal use Only
Submitted By:
*
First Name
Last Name
Email:
*
example@example.com
Company Number:
*
Company Name:
*
ZD Ticket Number:
*
Enter Zendesk ticket number for client request
Date Requested:
*
-
Month
-
Day
Year
Date
Billing Completed?
*
Please Select
Yes
No
Not Required
Waived
Date Billing Completed:
*
-
Month
-
Day
Year
Date of billing
Amount Billed:
*
Enter total amount billed for Amendments
PQA Completed?
*
Please Select
Yes
No
Not Required
Prior Quarter Adjustment (PQA)
If Yes, were funds collected for tax payments?
*
Please Select
Yes
No
Not Required
If Yes, enter the total amounts of funds collected for tax payments?
*
Reason for Amendment:
*
Amendment Year(s):
2024
2021
2023
2020
2022
2019
Amended Quarter(s):
Qtr. 1
Qtr. 2
Qtr. 3
Qtr. 4
941
940
State Withholding
State Unemployment
State Other
W2
W2C
1099NEC
Supporting Documents Required: Original Quarter End filings for each amended quarter, Payroll Summary and Labor Distribution Report for each check date adjusted, and any additional documentation needed for completion of amendments including any W-2C's if previously completed.
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Submit
Should be Empty: