Who is requesting information? Who is requesting information? An employer/HR verifying informationA third party (lender, landlord, background checker)An employee needing proof of employment/income What is the employer's name? Do you know the Employer's Name? Do you know the Employer's Name? YesNo Company or individual Who is the manager or supervisor? Ex. Jon Smith Title (optional) Ex. Manager Employer's contact information E-Mail Phone Number Employer's Address Street Address Address Line 2 City Please SelectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWashington DCWest VirginiaWisconsinWyoming State ZIP Code Requesting Party Name Individual or Company E-Mail Phone Number Do you know who is REQUESTING this verification? Do you know who is REQUESTING this verification? YesNo Such as an employer, landlord, government office, etc. Requestor's Name Individual or Company Requestor's Address Street Address Address Line 2 City Please SelectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWashington DCWest VirginiaWisconsinWyoming State ZIP Code Name of Employee (person being verified) Title or Role Ex. Account Manager Employee's original start date Employment Details Does the Employee work Full or Part Time? Does the Employee work Full or Part Time? Full-TimePart-Time How Many Hours per Week? Hours The Employee gets paid HourlyDailyWeeklyBi-weekly MonthlyQuarterlyAnnually (Salary) Select the way the employee receives payment. Enter Amount $/ Hour Enter Amount $/ Daily Enter Amount $/ Weekly Enter Amount $/ Bi-weekly Enter Amount $/ Monthly Enter Amount $/ Quarterly Enter Amount $/ Annually Does the employee earn any type of bonus? YesNo Approximate Bonus Amount ($): (annual basis) $/ Year Give an estimate of the Employee's Annual Bonus Amount (just an estimate does not need to be exact) Employer's signature Clear Please draw your signature. Print Name Next Save Save and finish later
