New Client

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Email Address *
Contact Information
First Name *
Last Name *
Contact Role *
Company Name *
Company Address*
State of Formation *
Principal Activity
Employer Identification Number (EIN) *
Tax Classification *
Other
Federal Tax Deposit Frequency *
State Name
State Tax Withholding Number
State Unemployment Tax Number
State Tax Deposit Frequency
State Name
State Tax Withholding Number
State Unemployment Tax Number
State Tax Deposit Frequency
First Check Date *
Payroll Frequency *
Pay Period Starts *
Pay Period Ends *
CustomPay is hereby authorized to sign and file employment tax returns on behalf of our company to Federal, State, and Local jurisdictions. CustomPay is authorized to receive notices, correspondence, transcripts, deposit frequency data, or other information regarding employment tax returns filed and deposits. This authorization shall be appropriate until the taxpayer notifies CustomPay that it should be terminated. I understand that this authorization does not absolve me as the taxpayer of the responsibility to ensure that all returns are filed and all taxes are paid on time. I certify that I have the authority to authorize the disclosure of this confidential tax data.
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