EIN
Full Name*
Company Name*
Company Type*
Email*
Responsible Party
Name of Responsible Party
Name*
Surname*
Does the Responsible Party have a SSN (Social Security Number) or an ITIN (Individual Taxpayer Identification Number)?
Responsible Party SSN (Social Security Number)
Company’s Physical Address
(No P.O. Box. It cannot be our address either)
Country*
Address Line 1*
Address Line 2
Domestic State*
City*
Post Code*
Company Information
Please describe your company’s business activity*
Do you have, or expect to have, any U.S. employees in the next 12 months?*
(Members/owners of the business are typically not considered employees.)
How many US employees do you expect to employ (maximum number) in the next 12 months?
First date wages or annuities were paid (month, day, year)?
Once you submit this form, you will receive an e-mail from us within the next 2 business days concerning additional required documents (i.e. copy of your passport) and signature request.
Contact Information
Country*
Address Line 1*
Address Line 2
Domestic State
City*
Post Code*
Phone Number*