Payroll Tax Withholding Waiver Request
Submit your request to waive payroll tax withholding for review and approval.
Full Name
*
First Name
Last Name
Employee ID
*
Department
*
Please Select
Finance
Human Resources
IT
Operations
Sales
Marketing
Other
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Employment Type
*
Full-time
Part-time
Contractor
Intern
Pay Period for Waiver Request
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Reason for Waiver Request
*
Requested Waiver Period (Start Date)
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Requested Waiver Period (End Date)
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Upload Supporting Documentation (if any)
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Signature
*
Submit Waiver Request
Submit Waiver Request
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