Verify Utah - Documented Employment Registry

*Company Name: (Required text field, max 64 characters)

Utah Entity Number: (Optional text field that accepts values with the following format: ######-#### or #######-####) -

*Company City (principal office): (Required text field, max 64 characters)

*Name of Person Filing Form: (Required text field, max 64 Characters)

Email of person filing form: Email will only be used to confirm payment and will not be publicly available.