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Ontact name/address Change payroll service information Please print. See backside for Instructions. Section 1 - Taxpayer Information 1. Taxpayer Legal Name 2. Doing Business As Name (if different from line 1) 3. Mailing Address 4. City, State & Zip 5. Contact Person for E-File 6. E-Mail Address for Contact Person 7. Phone Number for Contact Person 8. State Withholding Account Number (Your 9-digit federal ID plus the State's 2-digit suffix) Section 2 - Payroll Service Information Complet.

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