Business Registration Form - City Of Bethlehem Tax Bureau
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1City of Bethlehem Tax Bureau
Business Registration Form
All businesses and/or employers located in the City of Bethlehem and the Borough of Freemansburg are
required to register with the City of Bethlehem Tax Bureau. A Registration Fee of $25.00 must accompany this
Registration Form.
Instructions: Complete this form for each business location, answering all questions in full. Mail completed form, with payment, to City of
Bethlehem Tax Bureau, 10 East Church Street, Bethlehem, PA 18018.
Tax Office Use Only
Any questions—please call 610-865-7022
cAccount #
Business
Federal EIN No.
Name
Legal Name (if different from Business Name)
BUSINESS LOCATION IN BETHLEHEM (do not use PO Box)
Business Phone Number
Business Fax Number
Date Business Started at this Location:
[ ] New Business
[ ] Change of Ownership
[ ] Re-location
Type of Entity:
[ ] Sole Proprietorship
[ ] Partnership
[ ] Corporation
[ ] Temporary Vendor
[ ] Other ___________________
List Principal Owners, Partners or Officers
Name
Home Address (No PO Box)
Social Security Number
Title
Mailing Info
Contact Person
Title
For
Tax Forms
Address
Phone Number
Fax Number
Number of Employees:
Email
Special Notice: All individuals and organizations should notify the Tax Bureau of any change in address, ownership, partnership,
etc., promptly, so all records may be adjusted. If business is dissolved, please advise us within 30 days stating if same was liquidated
or sold. If sold, give date, name and address of new owners.
Please provide a brief description of the type of business conducted at this location:
I hereby certify that the answers above are true and complete to the best of my knowledge, information and
belief and are made in good faith.
Name
Phone #
Date
(print clearly)
Signature
Title
PLEASE USE REVERSE SIDE IF ADDITIONAL SPACE IS NECESSARY
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