23297 Commerce Park, Beachwood, Ohio 44122
www.payroll4free.com
855.PR4.FREE
SignerSet‐UpForm
Thisisthepersonwhowillberesponsibleforelectronicallysigningalldocumentsandformsonbehalfof
thecompany.Theywillbenotifiedbye‐mailifthereisaformthatrequirestheirattention.Youmay
designatemultiplesigners.
Company Name ______________________________________________________________
First Name _______________ *MI __ Last Name __________________ *Suffix ___
Title: __ Owner __ Assistant Treasurer
__ President __ CEO
__ Vice President __ CFO
__ Treasurer __ Authorized Signatory
Gender: M __ F __ SSN: ___ ___ ___ - ___ ___ - ___ ___ ___ ___
Date of Birth: ______________
Street Address 1: _____________________________________________________________
*Street Address 2: ____________________________________________________________
City: ______________________________ State: ______ Zip: ________________________
Phone: ___ ___ ___ - ___ ___ ___ - ___ ___ ___ ___ Email: __________________________
All fields are required, except those marked with *
