Form W-4This field is hidden when viewing the formUser Logged In?Create Form W-4This field is hidden when viewing the formContact InfoEmail* Already have an account? Login now.Employer InformationEmployer Name*Employer Address* Street Address City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Employer's Tax Id (EIN)*Employee InformationEmployee Name* First Last Employee Address* Street Address City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code SSN*First Date of Employment* MM slash DD slash YYYY Marital Status* Single Married Married, but filing separately Head of household Claim DependentsNumber of Children Under Age 17Number of Other DependentsClaim DeductionsOther Income (Not From This Job)If the you want tax withheld for any other income you expect this year, enter the amount here.Extra WithholdingIf you want additional tax withheld each pay period (paycheck), enter the amount here.Claimed Deductions* Standard Deduction You can choose to take the standard deduction or enter the total amount of itemized deductions you expect to claim this year.This field is hidden when viewing the formPDF PreviewClick refresh icon to see changes to the pdf.PDF Preview Full Screen Rotate your phone sideways for larger preview.Total $0.00 100% Money-Back Guarantee Complete satisfaction guarantee or your money back. PDF Preview Full Screen Rotate your phone sideways for larger preview. Almost there! Complete checkout to receive your PDF without watermarks or restrictions. Click “Previous” if you still have some edits to make.This field is hidden when viewing the formShow Modal CheckoutCheckout Now 100% Money-Back Guarantee Complete satisfaction guarantee or your money back.
