Former Employee Form

Please use this form if you are a former employee and need to change your mailing information, or if you have questions regarding tax forms, your 401(K) or other issues.

If you need to request a duplicate statement of your tax and wage (form W-2), please complete the following W-2 request form (20k PDF file*).

Former Employee Form
Name: (required) Address: City: State: Zip Code:	Phone: (required) E-mail: (required) Dates Employed: (required) Employee Number*: * If you do not know your employee number, please enter your last work location or your manager’s name.
Purpose of Contact: (required) Please provide a brief description to assist us in forwarding to the correct department.
Verification
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