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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.

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.