PayUSA New Clients

Please complete and submit the online form below. Thank you.

We appreciate the opportunity to work with you in providing a custom fit solution for your business needs. Please do not hesitate to contact us with any questions. You will receive a confirmation email with a PayUSA registration packet which will include: 

  • Signature Form
  • Payroll Service Agreement
  • Company ACH Authorization Form
  • Reporting Agent Authorization Form (IRS)
  • Power of Attorney and Declaration of Representative
  • Local Earned Income Tax Residency Certification Form (For PA companies only)

New Client Registration Form V2

  • General Company Information

  • Max. file size: 512 MB.
  • Business Address Actions
    There are no Entries.
  • This field is hidden when viewing the form
  • MM slash DD slash YYYY
  • Principal Name SSN Owner Title Owner % of Ownership Email Address Actions
    There are no Entries.
  • Max. file size: 512 MB.
  • Max. file size: 512 MB.

  • General Payroll Information

  • Please enter a number greater than or equal to 0.

  • 1st Payroll Period

  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
    (check all that apply, use the Other field, to list any additional items)
    (check all that apply, use the Other field, to list any additional items)
  • State NameState ID #Deposit Freq. 
  • State NameState UC ID #Contrib. Rate 
  • State NameCity/CountyDeposit Freq.Agency ID #Tax % Rate 
  • This field is hidden when viewing the form
    MM slash DD slash YYYY