Business Questionnaire Template - City Of Fairfield, Ohio Income Tax Division printable pdf download

City of Fairfield

BUSINESS QUESTIONNAIRE

Application for (Please check one):

____ Withholding Account

____ Net Profit Account **

____ Both Accounts

** A Net Profit Account must be applied for if performing business activities and/or generating income

within the City of Fairfield.

Name of Company: _________________________________________________________________________________

Doing Business as (DBA): ________________________________________

Fiscal Year End Date: _____________

Business and/or Fairfield, Ohio Address: ________________________________________________________________

Mailing Address: ___________________________________________________________________________________

Telephone Number: (____) _____-_______ Contact Person: ____________ Business Product/Service: _____________

Type of Business (Please check one): ____ Corporation ____ S-Corporation ____ Partnership ___ Sole Proprietorship

____ LLC (single member) ____ LLC (multiple members) ____ LLP

Date Began: Doing Business in Fairfield: ____________________ and/or Employee Withholding: __________________

Federal Id Number: ____________________ or Social Security Number, if sole proprietorship: ____________________

Number of Employees Working in Fairfield: ________

Number of Employees Residing in Fairfield: ________

Filing Payroll Taxes (Please check one): _______ Monthly (Mandatory if over $300.00 per month) ________Quarterly

Will a payroll company be filing the company’s withholding taxes? (Please check one):

____ Yes, name of the Payroll Company: ____________________________________

____ No

Does your company lease employees? (Please check one):

____ Yes, name of leasing company ________________________________________

____ No

If the company is replacing another company previously registered with the City of Fairfield (e.g. due to incorporation,

mergers, etc…), please indicate the name and FID number of the company: __________________________

_____________________________________________________________________________________________

Name and Address of Corporate Officers or Partners (or attach list): ______________________________________

_____________________________________________________________________________________________

_______________________________________________________________________________________________________

INCOME TAX DIVISION

5350 Pleasant Avenue, Fairfield, Ohio 45014 513-867-5327 Fax 513-867-5325

Business Questionnaire Template - City Of Fairfield, Ohio Income Tax Division