1. Please have a senior executive fill out and sign this electronic form - the specific fields you will be required to fill out are outlined in the section below. Please fill out every applicable field on all pages, and put <developer email> as the Business Email in Section 2 - External Administrator Information.
2. After the form has been signed by a senior executive, an email with the attached e-form will be sent to <Developer Name>; they will be the second signer.
3. After the form has been signed by both parties, <Developer Name> will email you the completed form. Please forward the completed form to your ADP representative and CC <developer custom email>

Page 2

• Client’s Legal Name: This is your company’s legal name
• Federal I.D Number
• Signature: The signature of the person filling out this form
• Name: The name of the person filling out this form
• Title: Your business title
• Date: The date you are signing this form

Page 3

• Effective Date: The date you are signing this form
• Client Name: This is your company’s legal name

Page 5

Company Information