W-2 Reprint/Redistribution Request

IMPORTANT NOTICE

Due to changing postal rates, once this form has been submitted, you will receive an invoice to submit payment online. Once payment is received, your request will be processed within 3 business days.

Current/Former Employee Information

Please enter all information as shown in our records.
Name on File
(Last Name, First Name, MI)
Full SSN
This form is secure and your personal information is protected
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Best Contact Phone Number
Please provide a phone number if you prefer to receive a phone call.
Email Address
example@example.com

Payment & Redistribution Information

How would you like to pay & How should we get the documents to you?
Tax Year(s) Requested
What Tax Form(s) are you requesting?
Please note, there is no additional cost for requesting both forms. Cost only increases $1 per tax year if multiple tax years are requested.
How many total years requested?
In order to make a payment online, you must know your Legacy-issued Employee ID. If you do not have this information, we will utilize your uploaded documents to verify identity and send it to you. Please indicate if you need your Employee ID emailed to you.
Redistribution Options (All options are Flat Rate)
- Base rate for reprint is $6.00.
- There is no additional charge for:
  - USPS First-Class Mail (Domestic)
  - USPS First-Class Mail (International)
- Rate increases based on current USPS rates.
  - Example: $6.00 + USPS Priority Mail Rate
Please click here to check current USPS Rates prior to making your selection.
All W2/1095 reprints must be obtained by visiting the central office at the address below. Pick-up at Mesquite or Plano campuses is not available.

375 Municipal Drive
Suite 222
Richardson, TX 75080
W2/1095 REQUESTS ARE ONLY MAILED THURSDAY. PAYMENT MUST BE RECEIVED NO LATER THAN CLOSE OF BUSINESS TUESDAY TO MAKE THURSDAY MAILING.
Please Note: We are only SENDING your document FROM a secure fax system. We are not responsible for misuse of your W-2 or any information it contains due to your choosing to have it faxed to an unsecure location. To protect your personal information, please only enter a secure fax number that only you have access to.
Please enter a secure fax number where you would like to receive your W2(s)
Please enter a valid fax numberFormat: (000) 000-0000.
Requested Forwarding Address

Enter full address in this box.0/1000
Verification of Identity & Signature
Please upload a valid government-issued ID such as a driver's license or passport

Cancelof
Signature (Please sign in the middle of the box)
Signature Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

IMPORTANT NOTICE

Current/Former Employee Information

Payment & Redistribution Information

Verification of Identity & Signature