Enrollment Documents - CLEAR Business Payroll Services...

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Business Payroll Services Contact and user designation form This form supplements the Payroll Service Agreement (the “Agreement”) between the Company identified below (“Company”) and Wells Fargo Bank, N.A. (“Bank”), which governs the payroll processing, payroll tax processing and ancillary services (collectively, the “Service”) provided by Bank to Company. The authorized bank account signer of the Company must complete and sign this form. Company information Company legal name FEIN DBA Company ID (for internal use only) Additional designated payroll contacts and users I, the authorized representative of the Company, hereby instruct Bank to grant to the individuals on this form, the designated access via phone, email, fax, mail, and/or online web access to Bank’s payroll software system. I understand that such access will allow a user to perform functions, including, but not limited to, the following: (1) accessing and updating Company payroll and human resource information for current and former Company employees; and (2) accessing, updating, approving and/or submitting payroll data for processing. Each user designation will remain in effect until written notice of revocation is provided to Bank and Bank has had a reasonable opportunity to act on it. I further understand that the Service and Company’s (and its users) use of the Service are subject to the terms and conditions of the Agreement (including any addendum and/or any online access agreement provided by Bank from time to time). First name Last name Email address Phone number Fax number Payroll contact : Primary contact Secondary contact Payroll assistant (limited) Online access level : Full Limited Reports Only* None wellsfargo.com user ID (if available) First name Last name Email address Phone number Fax number Payroll contact : Primary contact Secondary contact Payroll assistant (limited) Online access level: Full Limited Reports Only* None wellsfargo.com user ID (if available) Authorized representative information First name Last name Email address Phone number Fax number Payroll contact : Primary contact Secondary contact None Online access level : Full Reports Only* None wellsfargo.com user ID (if available) Authorized bank account signer of the Company Date Please fax the completed form to your Wells Fargo Business Payroll Services representative. *Reports only access will have visibility to all payroll reports and tax documents including W-2s and 1099s. © 2014 Wells Fargo Bank, N.A. All rights reserved. Member FDIC. BPS-OP-CUDF-110414 (Rev 01-9/14)
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Form 8655 (Rev. January 2012) Department of the Treasury Internal Revenue Service Reporting Agent Authorization OMB No. 1545-1058 Taxpayer 1a Name of taxpayer (as distinguished from trade name) 1b Trade name, if any 2 Employer identification number (EIN) 3 Address (number, street, and room or suite no.) City or town, state, and ZIP code 4 If you are a seasonal employer, check here . . . . . . .
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