Household Payroll Employer Worksheet
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2HOUSEHOLD PAYROLL EMPLOYER WORKSHEET
Date of Birth
HOUSEHOLD EMPLOYER CONTACT INFORMATION:
Please provide the full legal name of the employer (as it appears on your income tax return)
Mr. First Name
M.I.
Last Name
Social Security Number
Mrs.
Ms.
Address where work will be performed
Apt.
City
State
Zip Code
Home Phone
Cell Phone
Email Address
Preferred Method of Contact:
Home Phone
Cell Phone
Email Address
Date of Birth
SPOUSE CONTACT INFORMATION (if filing joint tax return):
SECTION 2: SPOUSE CONTACT INFORMATION (if filing joint tax return):
Mr. First Name
M.I.
Last Name
Social Security Number
Mrs.
Ms.
PRIMARY AGENT/FAMILY CONTACT INFORMATION:
Mr. First Name
M.I.
Last Name
Social Security Number
Mrs.
Ms.
Address
Apt.
City
State
Zip Code
Home Phone
Cell Phone
Email Address
Preferred Method of Contact:
Home Phone
Cell Phone
Email Address
ADDRESS WHERE PAPERWORK SHOULD BE MAILED (IF DIFFERENT FROM EMPLOYER ADDRESS ABOVE):
Address
Apt.
City
State
Zip Code
Home Phone
Cell Phone
Email Address
HOUSEHOLD PAYROLL SERVICE PLAN INFORMATION:
Electronic Service Offering:
Frequency of Pay:
Details of payroll service plan offerng:
Direct Deposit (DD)
Weekly
Electronic Tax Payments
(If unsure of your options, please contact us to discuss in more detail).
Payment of Monthly Invoices
ADDITIONAL TAX SET‐UP INFORMATION:
If Yes, Enter EIN Here:
Has the employer ever obtained or applied for a Federal Employer Identification
Number (FEIN) either for the household or as a Sole Proprietorship?
No
REDLIG FINANCIAL SERVICES INC. • 40 PRESCOTT AVENUE, SUITE 1L, WHITE PLAINS, NY 10605
WESTCHESTER: (914) 946‐7725 • NYC: (646) 827‐3600 • LONG ISLAND: (516) 935‐3950
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FAX: (516) 935‐3955
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Parent category: Business