Create Form W-4

Step 1 of 5 - Employee Info

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Form W-4
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Contact Info
Email*
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Employee Information
Employee Name*
First Last
Employee Address*
Street Address City State ZIP Code
SSN*
Marital Status*
- Single
- Married
- Married, but filing separately
- Head of household

Employer Information
Employer Name*
EIN*
Employer Address*
Street Address City State ZIP Code

First Date of Employment*
Date Format: MM slash DD slash YYYY
Claim Dependents
Number of Children Under Age 17
Number of Other Dependents
Claim Dependents
Other Income
If you want tax withheld for other income you expect this year, enter income amount here.
Claimed Deductions*
- Standard Deduction
Extra Withholding
Enter any additional tax you want withheld each pay period.

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Billing Address*
Street Address Address Line 2 City State ZIP Code
Credit Card*
Card Details
Cardholder Name
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