Wells Fargo At WorkSM Program Complete this form and a Wells Fargo At WorkSM representative will contact you within three business days. If you have any questions or are currently not a Wells Fargo Business Customer, please call 1-877-416-7677, 24 hours a day, 7 days a week. * = Required field Name* First Last Business Name* Number of Employees* (Talk to a banker about qualifications or restrictions) Business Address* City State Select One AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code Email Address* Phone Number* - - Primary Wells Fargo Business Account Checking Savings Loan Business Payroll Treasury Management Other Wells Fargo Banker's Name Do you have company locations in more than one state?* Yes No NOTE: Please do not send account numbers or account service requests through this form. If you have a question about an existing business account and you are a Wells Fargo Business Online® customer, Sign On to your account to send us a secure email.