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Your Trusted Fiscal Agent in Wisconsin

Thank you for choosing me as your fiscal agent in Wisconsin for services received through Inclusa, Inc. For a smooth start, please find the New Employer Packet available for download below. This packet includes all necessary documents and forms to complete your signup process.
New Employer Packet

New Employer Packet Download Instructions

Below is the full list of documents and forms in the above-linked packet. Use the link above to download the entire packet, or select from the documents below to download the individual files as needed.
Welcome/Intro Document
Self-Directs Supports Timesheet
Fiscal Employer Agent New Employer Checklist
Employer/Member Data Form
Member Authorization Form
Employer & Fiscal Employment Agency Agreement
Form SS-4: Application for Employer Identification Number
Form 2678: Employer/Payer Appointment of Agent

Ready to Assist You

Please don’t hesitate to contact me as soon as possible if you have any questions or concerns. Use the contact information below or fill out the online contact form.
Jean Gottwald, Fiscal Agent673 4th Avenue NorthPark Falls, WI 54552
Phone: 715-661-9101Toll Free: 888-689-7798Fax: 715-744-4999Email: info@jgfiscal.com
Address
13648 S Lakeview Circle Gordon, WI 54838
Service Area
Wisconsin
Phone
715-661-9101
Fax
715-513-7347
Email
admin@jlgfiscal.com
© Copyright 2025 JG Fiscal Services. All rights reserved. All registered trademarks herein are the property of their respective owners.

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