Employer Information
Part 1: Answer these questions for this quarter
Part 2: Tell us about your deposit schedule and tax
liability for this quarter
Part 3: Tell us about your business. If a question does NOT
apply to your business, leave it blank.
Part 4: May we speak with your third-party designee?
Part 5: Sign here. You MUST complete all three pages of
Form 941 and SIGN it
Use your cursor to sign your name above
Email Information
Insert the e-mail address to which you want to receive your 8995 form