Employee Claim Form « Tidewater Marketing Global Consultants, Inc.

Enter Information

Name (Individual / Company)(required)
Contact Person (If Different)
Street Address(required)
Mailing Adress (If Different)
City(required)
State(required)
Zip Code + 4(required)
SSN(required)
Telephone #(required)
Cell Phone #
Facsimile #
Email(valid email required)
Date Started Work(required)
Last date Worked(required)
Date Last Payment Received(required)
Amount of Last Payment(required)
For 2008 have You Received||
Form W-2 Form 1099MISC
I-9 Information: US Citizen
Yes No
Alien Registration #
Nationality
Amount Claimed(required)
Explain the basis for the amount claimed, including detailed computations, if any.(required)
Other Information Deemed Pertinent