Authorized Payroll Person
Name:
Please enter the first and last name of person at the business who is authorized to handle payroll. Persons working for a third party provider need to be listed under the offsite payroll contact.
Phone:
Enter the phone number to reach authorized payroll person at the business. Do not list phone number for third party provider.
Email:
Enter the email address for authorized payroll person.
Phone/Fax/Cell Phone
Enter the phone, fax, and cell phone numbers for the business. Do not list the phone, fax, or cell phone number for CPA, accountant, bookkeeper, or third party payroll provider.
Business Mailing Address
Enter the business mailing address.
Note: If address is outside the U.S., the address may be formatted incorrectly.
If billings are going to a third party (off-site payroll) an
Oregon Dept. of Revenue Power of Attorney is required, and address changes will not be updated until one is received. The POA can be found at www.oregon.gov, search box enter 150-800-005.
Contact Person at the offsite payroll service, accountant, or bookkeeper:
To update your accountant, bookkeeper, or third party payroll provider information without requiring forms or billings to be sent, leave the address responsibilities blank and fill in the rest of the page.
Enter the first and last name of person at the business who is authorized to handle payroll. This is for additional contacts at the business location. Persons working for a third party provider need to be listed under the Offsite payroll contact.
Physical Work Location
Enter the physical work location address.
Address cannot be a PO Box or Private Mail Box.
Note: Employee’s home addresses will not have information mailed to them. One of the physical addresses must be listed as primary physical.
Signer
The signer must be an owner/officer or someone delegated by an owner/officer from the business.