The above is not the government's logo
 1. THE NAME OF YOUR COMPANY
Registration Form:

Please note that any information you provide with this form is already public information. However, as an E-Verify Employer Agent on behalf of the DHS (Department of Homeland Security), I am bound by the Department's rules on privacy. No information, public or not, provided to me (Hal Netkin) has been, or will be shared with any other person or entity.
Following are the simple instructions to create an E-Verify account -- it's free, no setup charge, nor any monthly charge -- just $10.00 per query.

To register your company, fill in the blanks and click "Submit"
2. DBA (if different than above co name)
3. EIN (EMPLOYER ID NUMBER)
4. APPROX NUMBER OF MPLOYEES
(if no employees yet, enter zero)
5. CO FACILITY STREET ADDRESS
  Must be physical location where applicant          interviews take place   
Example: 245 W Elm Street, Anyville, CA, 90231
7. CO MAILING ADDRESS
(if different than facility address)​
Include City, State & Zip
Example: POB 1234, Anyville, CA, 90231
DOES OR WILL YOUR COMPANY        CONTRACT WITH ANY OF THESE      GOVERNMENTS (Check box if YES)
6. COUNTY OR PARISH
NAME OF PRINCIPAL COMPANY CONTACT
(Person who makes major company decisions,
not necessarily hiring administrator)
​TITLE OF ABOVE PRINCIPAL CONTACT
(e.g. President, Owner etc.)
NAME OF HIRING ADMINISTRATOR
(Person who will process I-9s)
(This can be the principal or anyone assigned to the position)
MAIN TELEPHONE NUMBER
FAX NUMBER
EMAIL ADDRESS
(Of assigned hiring
 designee)
HOW DID YOU HEAR ABOUT OUR SERVICE?

NUMBER OF COMPANY SITES
(these are secondary hiring
 locations of same company)
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Federal
State
Local