Form Ssa-1694 - Request For Business Entity Taxpayer Information - Social Security
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1
2Form Approved
OMB No. 0960-0731
Social Security Administration
Request for Business Entity Taxpayer Information
BUSINESS INFORMATION
Employer Identification Number (EIN)
Name of the Business Entity
Tax Mailing Address
P.O. Box, Street, Apt., or Suite No.
City
State
ZIP Code or Postal Zone
Country
PERJURY STATEMENT
I declare under penalty of perjury that I have examined all of the information on this request and it is true to the best of
my knowledge. I am aware that if I knowingly and willingly make any false representation about any material fact
provided herein or knowingly and willingly make any false representation to obtain information from Social Security
records, and/or attempt to deceive the Social Security Administration as to my true identity, I could be criminally
punished by a fine or imprisonment or both.
Printed Name
Signature
Date
/
/
Contact Name
Phone Number (including area code)
FOR AGENCY USE ONLY:
Form SSA-1694 (02-2013)
Page 1
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