Business Registration Questionnaire Form - City Of Allentown
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1
2CITY OF ALLENTOWN
BUSINESS REGISTRATION QUESTIONNAIRE
GENERAL INSTRUCTIONS: Complete applicable sections of the questionnaire, answering all questions in full. Please type or print. All registrants must
complete Signature Sections C and/or E. Mail completed form to: City of Allentown, Tax & Utility Systems, 215 City Hall, 435 Hamilton Street, Allentown,
PA 18101-1699. Any questions, please call (610) 437-7507. A payment of thirty-five dollars ($35.00) must accompany the Business Registration
Questionnaire.
SECTION A
This section must be completed for an Incorporated business or by persons who are Self-Employed and by each Partner of an
unincorporated business. Additional copies of this form are available upon request.
Business Name
Federal EIN No.
Legal Name (if different from Business Name)
Business Web Address
Sole Proprietor or Partner Name
Social Security No.
Business Location Address (Do not use PO Box)
City
State
Zip + 4
Business Telephone
(
)
Mailing
Contact Person
E-mail Address:
Address for
Tax Forms
Street or PO Box
City
State
Zip + 4
IF Sole Proprietor or Partner - State Principal employer if other than above
Business Telephone
Indicate Type of Entity:
[
] Sole Proprietorship
(
)
[
] Partnership
[
] Corporation
Address
City
State
Zip + 4
[
] S-Corp
Business Classification:
[
] Wholesale[
] Retail
[
] Service
[
] Manufacturing
[
] Rental
Nature of Business (brief detailed description)
LIST PRINICIPAL OWNERS, PARTNERS OR OFFICERS
Name & Title
Home Address (No PO Box)
Social Security No.
Home Telephone No.
(
)
(
)
(
)
City or township/school district where you reside
Date Business Started in City of Allentown
Date Incorporated
State of Incorporation
Do you or will you have amusement devices?
[
] No
[
] Yes, # of Devices:
No. of Employees (exclude self)
LIST ALL OTHER CITY OF ALLENTOWN BUSINESS NAMES AND ACCOUNT NUMBERS
Business Name
Account No. (QW, MW, EW, SP, RE)
SECTION B. This section MUST BE completed for ALL businesses operating in the City of Allentown.
Name:
Telephone No.: (
)
Tax Preparer Info
Address:
City:
State:
Zip + 4:
Name of Bank:
Account No:
Bank Officer Name:
Telephone No.: (
)
Principal Bank
Address:
City:
State:
Zip + 4
SECTION C. I hereby certify that the above information and statements are true and correct.
Signature:
Title:
Date:
Business Account No.
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