Company Legal Name *

Doing Business As (if applicable)

Address *

City *

State *

Postal code *

Please complete and sign the documents below:

Limited Power of Attorney

ACH Authorization Form

Beneficial Owner Form

Company Website

Payroll Contact *

Contact Title *

Email *

Primary Phone *

Executive Contact *

Executive Title *

Executive Email *

Executive phone *

Pay Frequency *

Monthly (12)

Semi-Monthly (24)

Bi-Weekly (26)

Weekly (52)

Next Check Date *

Next Period End Date *

Federal EIN *

Federal Tax Deposit Frequency *

Semi-Weekly

Monthly

What state do you do business in? *

State Withholding ID # (if applicable)

State Withholding Deposit Frequency

State Unemployment ID # *

State Unemployment Tax Rate *

Does your company operate in other states?

Upload the completed POA, ACH Authorization and Beneficial Owner forms *

Federal Proof Document *

Copy of Form SS-4 or any document received from the IRS that shows the company name, EIN and address

Company Banking Documentation *

Must be a voided check or official bank documentation that shows the company name, address, routing, and account number

Click here to download the Employee Data Spreadsheet. Once completed, upload it in the following step.

Employee Data Upload *

Listing of employee demographics including direct deposit information including any benefits, and deductions

Prior Quarter Payroll/Tax Information (if applicable)

Summary of wages paid by employee, a listing of tax payments made by date, and any unpaid tax liabilities for the previous quarter(s)

Current Quarter Payroll/Tax Information (if applicable)

Summary of wages paid by employee, a listing of tax payments made by date, and any unpaid tax liabilities for the previous quarter(s)

Signature *

Clear

Signature of Authorized Party

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