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Company Information

Company Name(Required)

Business DBA (If any)

Organization Structure

LLC

Corporation

Partnership

Sole Proprietor

Sub Entity

S-Corp

Single Member LLS

Partnership

Organization Date

Business Description

Company Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Business Phone Number(Required)

EIN #

Utah Entity #

State Withholding Account Number (If any or if applied) Ends with -WTH

Utah Unemployment Number (Work Force Services) Starts with C-

Estimated Payroll Amount you expect to pay this year

Pay Date Frequency

Monthly

Bi-Monthly

Bi-Weekly

Weekly

Company Bank Routing Number

Company Account Number (Checking)

Business Owner Name

First Last

Business Owner Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Business Owner Cell Number

Business Owner SSN

Prior Payroll this Calendar Year

Do you have prior payroll this calendar year?

Yes

No

Last Pay Date Processed

Do you have access to EFTPS?

Yes

No

Not Sure

Do you have access to Utah TAPS

Yes

No

Not Sure

Employee Information

Employee

Employee Name (First and Last)

W4 Completed

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Direct Deposit Form

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Click here to find the direct deposit form.

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone #

Personal Email

Birth Date

Hire Date

Cell #

SSN

Job Title

Pay Rate (Hourly or Salary)

Employee Direct Deposit Bank Routing #

Employee Direct Deposit Account #

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Email

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Company Information

Prior Payroll this Calendar Year

Employee Information

Employee Information

Employee