Employer Information Form printable pdf download

Employer Information Form

SOUTHERN LEHIGH SCHOOL DISTRICT E.I.T. OFFICE

5550 Route 378

P. O. BOX 130

CENTER VALLEY, PA. 18034

PHONE-610-974-9510

FAX—610-974-8510

This form must be filled out completely and can be returned either with your

Employer’s Quarterly Return or as a separate mailing. Please note it may be faxed

to the fax number listed above.

If you use a payroll company please insert their name here:

Name:

Address:

Contact Person:

Thank you in advance for your cooperation.

Paul E. Bauer

EIT Supervisor

EMPLOYER INFORMATION FORM

BUSINESS NAME_____________________________________________________

EIN#______________________Opening date of business_____________________

1. Type of Business:

Retail___Wholesale_____Mfg.________Other____________

2. Number of employees________________________________

Business owner’s name:________________________________________________

Address:_____________________________________________________________

____________________________________Home Phone______________

Business address:_____________________________________________________

_____________________________________________________

PHONE #_____________________________FAX #___________________

LOCATION: COOPERSBURG ( ) UPPER SAUCON ( ) LOWER MILFORD ( )

Please be sure to complete all the columns on the Employer’s Quarterly Reports. A

Quarterly return must be sent with a check for the payment of the taxes withheld

for each quarter. If no wages are paid in a given quarter, please send in the report

and indicate 0 wages.

Please return this form with your next quarterly report. Should there be any

questions, please telephone us at the number listed above. Our office hours are 8:00

to 4:30, Monday thru Friday.

I hereby certify the above information is true and complete to the best of my

knowledge,

SIGNATURE_______________________________TITLE______________________

DATE___________________________________

Employer Information Form