W-2 Electronic Delivery Consent Form
Use this form to authorize electronic delivery of your W-2 and provide the contact details needed to receive it. Please review the consent carefully before submitting.
Recipient Information
Full Legal Name
*
First Name
Middle Name
Last Name
Employee ID or Internal Identifier
Department or Work Group
Please Select
Accounting
Human Resources
Information Technology
Sales
Operations
Other
Electronic Delivery Contact Details
Email Address for W-2 Delivery
*
example@example.com
Mobile Phone Number for Delivery Notifications
Please enter a valid phone number.
Format: (000) 000-0000.
Preferred Contact Method
Email
Phone
Delivery and Access Preferences
Preferred Delivery Channel
*
Email only
Email plus portal access
Notify Me When W-2 Is Available
*
Yes
No
Backup Email Address
example@example.com
Signature and Submission
E-Signature
*
Date of Consent
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Consent
Submit Consent
Should be Empty: