Form Rd-100 - Registration Application printable pdf download

CITY OF KANSAS CITY, MISSOURI

FINANCE DEPARTMENT

REVENUE DIVISION

REGISTRATION APPLICATION

Phone - (816) 513-1135

414 East 12th Street

RD-100, Rev-11/04

Kansas City, Missouri 64106-2786

REASON FOR SUBMITTING REGISTRATION FORM IS TO ESTABLISH (check all that apply):

[ ] Business License Account

[ ] Withholding Account

[ ] Profits Account

[ ] C&T Account - Rooms

[ ] C&T Account - Food

[ ] Wage Earner Account

[ ] Other: _________________________________________

Missouri Sales Tax Number

Federal Employer ID No. (FID/SSN)

Business/Trade/DBA Name:

Legal Name as Incorporated OR Sole Proprietorship Name

Legal (Mailing) Address

County

Local Business Address (if any)

Local Business Telephone Number (if any)

Business Telephone Number

Contact Person

GENERAL INFORMATION

Type of Organization

Type of Business

Classification of Business

[ ] Corporation

[ ] Retail Trade

[ ] Finance

[ ] Profit

[ ] Trust/Assn.

[ ] Wholesale Trade

[ ] Real Estate

[ ] Non-profit

[ ] Individual

[ ] Manufacturing

[ ] Service

If not-for-profit, attach copy of

[ ] Fiduciary

[ ] Construction

[ ] Hotel/Motel

exemption certificate.

[ ] Partnership

[ ] Governmental

No. of rooms: ________

[ ] Voluntary Withholding Only

[ ] Limited Liability Company

[ ] Restaurant

[ ] Other, specify:

(Nonresident employers)

[ ] Other, specify:

______________________

_______________________

Will you be bidding on city contracts or have you bid on city contracts in the past?

[ ] Yes

[ ] No

Date of incorporation:

State of incorporation:

KCMO business start date:

Fiscal year-end date:

Number of KCMO employees:

Describe (in detail) nature of business performed in KCMO:

List all owners, partners, or officers (attach additional names on separate sheet):

Name

Home Address and Telephone Number

Position

Social Security Number

For office use only (enter account ID):

[ ] OCC ______________________

[ ] WIHO ______________________

[ ] PROF ______________________

[ ] CTRO _____________________

[ ] CTFO ______________________

[ ] WE

SIC CODE ____________

Under penalties of perjury, I declare this information is true, correct, and complete.

Signature

Title

Date

Form Rd-100 - Registration Application

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