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Employer Information
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Your Information (* required): |
Spouse's Information: |
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First Name (*):
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First Name: |
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Last Name (*):
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Last Name: |
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Social Security Number:
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Social Security Number: |
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Contact Information: |
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Street Address:
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Is this an
unincorporated area? |
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Address Line 2:
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Daytime Phone (*):
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Home Phone: |
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Email Address: |
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Employee/Payroll Information
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First Name: |
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Street Address:
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Last Name:
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Address Line 2:
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Social Security Number: |
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City: |
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State: |
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Zip: |
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Salary: |
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Date of first paycheck: |
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Paid: |
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Marital Status : |
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Number of Income Tax Exemptions: |
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Additional Information
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If you have any additional information you would like to provide us, please enter
it below. |
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If you have previously registered with the government for payroll
withholding, please provide the following information. If you have not previously
registered, The Nanny Tax Company will prepare the appropriate forms to register
you.
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Registration Fee
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We cannot process your registration without receiving payment. There are three options
for payment. You can submit your credit card information along with this form below.
You can print and either (1) fax this registration form along with credit card information
to (773) 327-8102 or (2) mail this registration form and a check to: |
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The Nanny Tax Company
2149 W. Roscoe, Suite 1
Chicago, IL 60618
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$400.00 |
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The $400 annual fee is for the preparation of payroll
tax forms for one employee earning over $4,000 per year. Special rates are offered
for employees earning less than $4,000 or for employers with more than one employee.
Please contact
The Nanny Tax Company
at (800) 747-9826 for more information.
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+$100.00
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One-time set up fee
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$500.00
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Total
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Please enclose a check or provide us with your credit card information: |
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Type of card: |
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Card Number:
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Exp. Date (MO/YR): |
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Employer Signature
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I hereby authorize The Nanny Tax Company to prepare the forms necessary to register
me with the appropriate government agencies and to prepare my domestic payroll tax
forms. The information I have provided on this form is accurate to the best of my
knowledge and The Nanny Tax Company may rely on this information to prepare my payroll
tax forms. I understand that while The Nanny Tax Company will prepare the tax forms
for me, I remain responsible for reviewing the prepared forms, signing them and
submitting them to the government. I also understand that I am the withholding agent
for my employee, and that I am solely responsible for paying withheld taxes to the
government. If you are paying by credit card, clicking on the submit button below,
gives The Nanny Tax Company permission to charge your Registration Fee to your credit
card. |
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