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Registration Instructions

Please read the Instructions before you proceed with the registration process.

Complete ALL of the information below. After completing the form, click the Continue button to complete the process.

If you have used our web site to report your new hires, you do not need to register again. If you have forgotten your password, click here.

The Employer ID should be your nine digit Federal Employer Identification Number assigned by the IRS (with no dashes). If you do not have a Federal Employer Identification Number, we provide IRS Form SS-4 for your convenience (requires free Adobe Acrobat Reader).

Please enter a Password that you will remember easily. The Password must be at least five (5) characters and no more than nine (9). You may use letters and numbers in your Password.


Registration Form

Employer ID  No dashes
Password  No ! # % * or spaces
Re-type Password 
 
Employer Name 
Employer Address Line 1 
Address Line 2  Optional
City 
State 
Zip Code  - First 5 Required. +4 optional.
Employer Phone  Include Area Code. No dashes. Ex: 8035551234
 
Contact Person 
Phone Number  Include Area Code. No dashes. Ex: 8035551234
E-mail Address  Ex: jsmith@aol.com