1. To Instructions

Director, Submission Processing

Processing Center

3. Employer's or Payer's Address (Number and street, city, town or post 

 office, State and ZIP Code)

2. Employer's or Payer's Name

4. Employer's Identification Number

5. Agent's Name 6. Agent's Address

7. Agent's Employer Identification Number

 8. Effective For (Check the box or boxes that apply)

 Employment Taxes (Rev. Proc 70-6)

 Backup Withholding (Rev. Proc. 84-33)

Yes No

Date

Title of signing official (Indicate whether the person signing is an 

owner, partner, member of firm, fiduciary, or a corporate officer)

For Internal Revenue Service Use Only

Effective Date Granted by IRS

Form 2678

(Rev. June 2002)

Department of Treasury- Internal Revenue Service

Employer Appointment of Agent 

Under Section 3504 of the Internal Revenue Code

OMB Number

1545-0748

Employer or Payer: Please complete 

this form and give it to the Agent.

Agent: Please attach a letter 

requesting authority to do either all that 

is required of the employer for wages 

you pay on the employer's behalf or all 

that is required of the payer for 

requirements of backup withholding. 

(See applicable Revenue Procedures 

70-6 or 84-33.) Forward both the letter 

of request and Form 2678 to the 

Internal Revenue Service Center 

Director, Submission Processing where 

you file your Form 941 returns.

9. If Filing under Rev. Proc.

 70-6, does this apply to all

 employees?

10. Effective Date of

 Appointment by Employer

 or Payer

Signature of Employer or

Payer

Under Section 3504 of the Internal Revenue Code, 

please authorize this agent to do all that is required

under (Check the one(s) that apply)

 Chapter 21 (FICA)

 Chapter 22 (Railroad Retirement)

 Chapter 24-

 Withholding and/or

 Backup Withholding

 Chapter 25 (General Provisions) of Subtitle C

NOTE: Appointment of an Agent under Section 3504 does 

NOT apply to Form 940, Employer's Annual Federal 

Unemployment Return (Chap. 26 of the Internal Revenue 

Code).

The agent named above has been appointed either to 

pay wages for employers and/or report and deposit 

backup withholding amounts for payers. This 

appointment is effective on the date shown in item 10. 

It is understood that the Agent and the employer or 

payer are subject to all provisions of law and 

regulations (including penalties) which apply to employers 

or payers.

Catalog Number 18770D Form 2678 (Rev. 6-2002)
Paperwork Reduction Act Notice

We ask for this information to carry out the Internal Revenue laws of the United States. We need it to ensure 

that taxpayers are complying with these laws and to allow us to figure and collect the right amount of tax. You 

are required to give us this information. The time needed to complete this form will vary depending on the 

individual circumstances. The estimated average time is: 30 minutes. If you have comments concerning the 

accuracy of this time estimate or suggestions for making this form more simple, we would be happy to hear 

from you. You can write to the Tax Form Committee, Western Area Distribution Center, Rancho Cordova, CA 

95743-0001. DO NOT send this form to this address. Instead, send it to the Director of the Internal Revenue 

Service Center where you file your returns.

File with the 

Internal Revenue Service, 

Submission Processing Center at:

Cincinnati, OH 45999

Ogden, UT 84201

Philadelphia, PA 19255

Catalog Number 18770D Form 2678 (Rev. 6-2002)