UC Tax Inquiry

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Please provide the following information.

Required fields are marked with an asterisk(*).

First Name

*

Last Name

*

Title

*

Address Line 1

*

Address Line 2

*

Country

City

*

Zip Code

*

State/Province

State/Province

State/Province

Telephone Number

*

Telephone Number Ext

*

Requestor Type

EmployerTPA

Email

**

Confirm Email

**

Federal Employer Identification Number

*

Legal Name

*

Account Number

*

Response Preference

Subject

Message

*

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