Free Electronic Filing Agreement - Tennessee

STATE OF TENNESSEE DEPARTMENT OF LABOR AND WORKFORCE DEVELOPMENT DIVISION OF EMPLOYMENT SECURITY EMPLOYER ACCOUNTS OPERATIONS 220 FRENCH LANDING DRIVE NASHVILLE, TENNESSEE 37243 FAX 615-741-7214

ELECTRONIC FILING AGREEMENT
Employer Name: ____________________________________________________________________________ State UI Account Number: ______________________ Contact Person: ______________________________ E-mail Address: ___________________________________ Federal EIN: ____________________________ Telephone Number: ______________________ Fax Number: ___________________________

This is an agreement between the Tennessee Department of Labor and Workforce Development (hereinafter "TDLWD") and _______________________________________________________ (hereinafter "the Employer"), entered into this on this the ___________ day of ___________________, ________ pursuant to the provisions of TCA §50-7-404, Rule 0560-2-1 et. seq. TDLWD and the Employer agree as follows:
1. The TDLWD authorizes the Employer to file the quarterly premium and wage reports required by the above provisions by means of transmission of data by modem to the Department's Bulletin Board System. The signature on this Agreement shall be deemed to appear on any transmission received by TDLWD's Bulletin Board System. This Agreement constitutes electronic filing which satisfies the law requiring an employer or employer's agent reporting 250 or more employees to file wage items by magnetic media. This agreement does not change or substitute for any other legal requirements, including due dates. This Agreement will be effective beginning _________________ quarter/year.

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Employer or Agent Signature _________________________________ Employer or Agent Name Printed _____________________________ Title _____________________________________ Date _________________

Employer or Agent Telephone Number ___________________ TDLWD Official Signature ___________________________ Title _______________________________ Date _________________

LB-0962 (Rev. 04-08)