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Service Cancellation Form
Enter the same email address which you signed in with:
Applicable company codes:
For multiple companies, enter all company codes separated by a comma. IE. 9999, 9999A, 9999B
Final Pay Date to Be Processed in Empeon:
Reason for Termination
Customer Service Issues
Out of Business
Please explain the reason
New Payroll Vendor Name?
For the terminating companies, what is final quarter that Empeon will process the quarterly returns for?
Do you require Empeon to prepare W2s for the companies that are being terminated?
(Year in which the companies are terminating)
Yes (Payment of $5.25 per form will be required prior to release)
Client Tax Filing
For the year in which the companies are terminating
Mid-Quarter ($250 fee to reconcile taxes, no filing)
End-Quarter ($25 filing fee per Quarter-end report)
Year-End (filing fees QE $25, W2 $150, Per State $150)
Please Provide Details: