Texas Application For Payee Identification Number
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1
2AP-152
For Comptroller's use only
(Rev.6-07/10)
CLEAR ALL FIELDS
TEXAS APPLICATION FOR PAYEE IDENTIFICATION NUMBER
• Shaded areas for state agency use only
• See instructions on back
1. Is this a new account?
YES
Mail Code 000
NO
Enter Mail Code
Agency number
Complete Sections I - V
Complete Sections I, II & V
2. PAYEE IDENTIFICATION NUMBER (PIN) - Indicate the type of number you are providing to be used for your PIN
1 - Federal Employer's Identification (FEI) Number
2 - Social Security Number (SSN)
Enter the number indicated
3 - Comptroller's assigned number
3. Are you currently reporting any Texas tax to the Comptroller's office other than unemployment (e.g., sales tax, franchise tax)?
YES
NO
If "YES," enter Texas Taxpayer number .....................
PAYEE INFORMATION (Please type or print)
4. Name of payee (Individual or business to be paid)
5. Mailing address where you want to receive payments
6. (Optional)
7. (Optional)
8. (Optional)
9. City
State
ZIP code
Zone code
10.
Payee telephone number
SIC code
(Area code and number)
Security type code
( 0, 1, 2 )
11. OWNERSHIP CODES - Check only on code by the appropriate ownership type that applies to you or your business.
I - Individual Recipient (not owning a business)
J - Joint Venture
E - State Employee
If checked,
L - Limited Partnership
If checked, enter the Texas
enter employing agency number ............
File Number
S - Sole Ownership (Individual owning a business) If checked,
enter the owner's name and Social Security Number (SSN)
T - Texas Corporation
If checked, enter the Texas
Owner's name
Charter Number
2
SSN
A - Professional Association
If checked, enter the Texas
P - Partnership
If checked, enter two partner's names
Charter Number
and Social Security Numbers (SSN). If a partner is a
corporation, use the corporation's Federal Employer's
C - Professional Corporation
If checked, enter the Texas
Identification (FEI) Number.
Charter Number
SSN/FEI ..........
O - Out-of-State Corporation
Name
G - Governmental Entity
SSN/FEI ..........
U - State agency / University
Name
F - Financial Institution
Type of service provided
R - Foreign (out of U.S.A.)
N - Other
If checked, explain.
12. Payment Assignment?
YES
NO
Note: A copy of the assignment agreement between payees must be attached.
Assignee name
Assignee PIN
Assignment date
13. Comments
Authorized signature (Applicant or authorized agent)
Date
14.
Agency name
Prepared by
Phone (Area code and number)
15.
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Parent category: Legal