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Form Submission Problem

While our new service request form works correctly for most employers, some users are experiencing issues that prevent submission:

Service options not displaying fully;
User account number not recognized;
Form not submitting (the "spinning icon");
Different issues.

Intermittent issues are the hardest to solve so if you are unable to submit the service request form, please tell us about it below. We will submit service requests for you until we figure out what's going on!

Your email address(Required)

Please describe the problem that is preventing submission.(Required)

(Check all that apply.)

My user account number isn't being confirmed.

The 'Service Type' field isn't displaying the choices.

The icon 'spins' and the form doesn't submit.

I saw an error message.

I experienced a different problem.

Browser(Required)

What browser or operating system are you using?

What is your user account number?(Required)

The error message(Required)

Please copy and paste or describe the error message here.

Describe the problem.(Required)

May we submit the service request for you?

Yes, please!

Your name(Required)

First Last

Your company name(Required)

(This is how it will appear on Form I-9.)

Company address(Required)

(Also for the I-9)

Street Address Address Line 2 City State ZIP Code

The employee's name(Required)

First Last

The employee's email address(Required)

Enter Email Confirm Email

The employee's start date(Required)

MM slash DD slash YYYY

Service Type(Required)

Full Form for a New Hire

Section 2 Only for a New Hire

Supplement B Reverification

Other

E-Verify(Required)

Does your company participate in the E-Verify program?

Name

This field is for validation purposes and should be left unchanged.

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