12-793-6296 Account No. Employer located at ( (Street Address, City, State, Zip Code) ) ( 847 ) 550-3000 Telephone Number Telephone Number E-mail Address hereby authorizes The Austin-Gregg Corporation located at TAGC001 1180 Heather Drive, Lake Zurich, IL 60047 (Street Address, City, State, Zip Code) E-mail Address payroll austingregg.com to represent the Employer before the Director in any and all matters, to act in the Employer s stead with the same consequences as the Employer,.
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