Form Wv/bus-App - West Virginia Office Of Business Registration
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WEST VIRGINIA OFFICE OF BUSINESS REGISTRATION
WV/BUS-APP
PAGE 1 OF 3
INSTRUCTIONS FOR COMPLETION ARE FOUND ON PAGE 11 OF THE BOOKLET
Rev. 01-13
SECTION A : COMPLETE THIS SECTION TO REGISTER WITH THE WEST VIRGINIA STATE TAX DEPARTMENT
1. West Virginia Taxpayer Identification Number:
If you have a Federal Employers Identification Number, enter it. (All partnerships, corporations, and sole-owners with
employees must have a FEIN). If sole-owner (no employees), enter social security number.
2. Business name and actual physical location
3. Mailing address (where returns are to be sent)
Legal business or corporate name (Type or print using blue/black ink)
Name (Type or print using blue/black ink)
Check here if mailing address same as business address
DBA division, subsidiary, or trade name
Additional space for name if needed
Owner’s name (if sole owner)
Check to use address on other business registration forms
Address (Street) DO NOT USE A POST OFFICE BOX NUMBER
Address (Street or P. O. Box)
City
State
Zip code
City
State
Zip code
4. NAICS/Business Description (Refer to to obtain NAICS information):
Click here for NAICS Business Codes
Description of your business activity (REQUIRED):
Enter primary NAICS:
Secondary NAICS:
5. Business Data:
A. Beginning date of business in West Virginia for the location entered in item 2 on this application: _______________________________________
B. County where business is located. NOTE: County must match city in item 2 above. ________________________________________________
C. Contact Information: Name: ____________________________________________________ Telephone #: ______________________________
D. E-mail address: _______________________________________________________________________________________________________
E. Estimated annual gross income for this location:
0 – $20,000
over $20,000
F. Previous name of this business, if any, owner’s name and location: _______________________________________________________________
____________________________________________________________________________________________________________________
G. Are you now or have you ever been registered to do business in West Virginia?
Yes
No
If yes, give name and West Virginia Identification Number: ______________________________________________________________________
H. If you have other locations registered or multiple business locations being registered, do you desire to file consolidated tax returns?
Yes
No If yes, enter taxes to be consolidated and West Virginia Identification Number you desire to file under:
____________________________________________________________________________________________________________________
I. Taxable year end for Federal Tax purposes – Enter month: ______________________________________________________________________
J. If nonprofit, do you have 501-C exemption status from the IRS?
Yes
No
If yes, attach copy of determination letter (REQUIRED)
You must have a control
K. Enter 5-digit Control Number assigned by the Secretary of State’s Office, if applicable
number to submit this
A control number is not required for sole proprietorship or general partnership.
application
6. Enter type of business ownership:
Z Other (Specify below)
A Sole-Owner
D1 General Partnership
E Joint Venture
B Domestic Corporation
D2 Limited Partnership
F Association
C Foreign Corporation
D3 Limited Liability Partnership
G Limited Liability Company
D3 Limited Liability Partnership
Partners – Members – Officers – Owners (Required):
NAME
HOME ADDRESS
SOCIAL SECURITY NUMBER
HOME TELEPHONE NUMBER
7. Check appropriate boxes:
A Operate a collection agency
F Sell tangible personal property to consumers at retail level and do not maintain an
established place of business in West Virginia (transient vendor). $500 bond or certified
B Operate an employment agency
check and BRT-803 are required.
C Make consumer loans
G Use commercial weighing or measuring devices (i.e. scales, gas pumps, etc.)
D Make supervised loans
H Offer or sell goods or services to West Virginia Consumers by Telemarketing
E Non-Resident Contractor
I None of the preceding
8. Type of Activity:
A Service
C Wholesale
E Construction
G Manufacturing
B Retail
D Both (Retail & Wholesale)
F Rental
Z Other (Specify – Attach Information)
I certify this application to be true and correct to the best of my knowledge.
SIGNATURE ______________________________________________________
*b29201301W*
(SIGNATURE REQUIRED)
TITLE ____________________________________
DATE ________________
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