Submit Your 1095Hawk Service Request Thank you for choosing 1095Hawk to prepare, deliver and e-file your 1095 forms for 2016. Please complete the form below. Enter your name in the signature box to electronically sign the contract. 1095Hawk Overview Your Name* First Last Employer Name*Employer Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Enter Email Confirm Email Phone*Estimated number of employees:*Number of EINs that generate payroll:*If you were referred by someone, please provide contact's name and name of company):CommentsBy signing below, you are agreeing to engage the services of 1095Hawk, a service of Hawkins Ash CPAs, LLP. The pricing will be based on the number of 1095 forms prepared at the pricing shown on our pricing page. After clicking on "Submit Your Contract", you will receive a contract for services.Signature*Please enter your full name to serve as your digital signature.(After clicking the Submit button, it will take a few seconds to process, please be patient.)NameThis field is for validation purposes and should be left unchanged.