Nanny Tax Prep

Employer Information

Your Information (* required):

First Name (*):
Last Name (*):
Social Security Number:

Spouse's Information:

First Name:
Last Name:
Social Security Number:

Contact Information:

Street Address:
Address Line 2:
City:
State:
ZIP:

County:
Daytime Phone (*):
Home Phone:
Email Address (*):

Employee/Payroll Information

First Name:
Last Name:
Social Security Number:

Street Address:
Address Line 2:
City:
State:
ZIP:

Salary:
Amount is:	Before Taxes After Taxes
Paid:	weekly bi-weekly other
Number of State Allowances

Date of hire:
Date of first paycheck:
Marital Status:	Married Single
Number of Federal Allowances

Additional Employee

First Name:
Last Name:
Social Security Number:

Street Address:
Address Line 2:
City:
State:
ZIP:

Salary:
Amount is:	Before Taxes After Taxes
Paid:	weekly bi-weekly other
Number of State Allowances

Date of hire:
Date of first paycheck:
Marital Status:	Married Single
Number of Federal Allowances

Remove Employee

Add Another Employee

Additional Information

If you have any additional information you would like to provide us, please enter it below.

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.

Federal Employer Identification #:
State Withholding Tax #:
State Unemployment Insurance #:

Employer Signature

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.