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Get LA LWC-ES1 2008-2024

OYMENT ACCOUNT FOR OFFICAL USE ONLY ACCOUNT NO. PLEASE REVIEW THE INSTRUCTIONS ON THE NEXT PAGE BEFORE COMPLETING THIS FORM 1. EMPLOYER or CORPORATION NAME 2. LA WITHHOLDING NUMBER (Legal name is mandatory) 3. TRADE NAME or DBA NAME 4. FEDERAL EMP. I.D. NUMBER 5. MAILING ADDRESS (P.O. BOX OR STREET) CITY STATE ZIP CODE 6. FAX NUMBER 7. PHYSICAL LOCATION IN LOUISIANA mandatory (STREET) CITY STATE ZIP CODE 8. TEL. NO. & EXT. (PHYSICAL LOCATION) 9. NAME OF CONTACT PERSON WITH P.

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