Form St 1s - Application For Service Vendor'S License - 2009
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1Reset Form
hio
ST 1S
Department of
Rev. 12/09
Taxation
Application for
07100100
P .O. Box 182215
Service Vendor's License
Columbus, OH 43218-2215
(888) 405-4089
Vendor's license no.
(For department use only)
Federal employer identifi cation no.
Ohio corporate charter no. / certifi cate no.
Social Security no. / ITIN
1. Check type of ownership: (10) Sole owner
(20) Partnership
(30) Corporation
(150) Nonprofi t
(50) LLC
(70) LLP
(80) LTD
Other (please specify)
2. When did you or will you begin providing the taxable service in the state of Ohio? (MM/DD/YY)
(For the most current listings, search
3. Provide NAICS code and state nature of business activity
NAICS on our Web site at tax.ohio.gov.)
4. Legal name
(Corporation, sole owner, partnership, etc.)
5. Trade name or DBA
6. Primary address
Address of corporation, sole owner, partnership, etc.
City
State
ZIP code
Business phone no.
Fax no.
Secondary phone no.
7. Mailing address
(If different from above)
City
State
ZIP code
8. How much sales tax do you expect to collect each month Less than $200
$200 or greater
9. If you operate as a corporation or partnership, list appropriate names, addresses and identifi cation numbers below.
Title
Name
Street
City
State
ZIP code
SSN / ITIN / FEIN
Title
Name
Street
City
State
ZIP code
SSN / ITIN / FEIN
Title
Name
Street
City
State
ZIP code
SSN / ITIN / FEIN
10. Name, phone number, fax number and e-mail address of individual the department should contact regarding this ac-
count
Name
Phone no.
Fax no.
E-mail address
Date
Signature of applicant
Fee for this license – $25 (made payable to Ohio Treasurer of State). Send the original application and $25 fee to
the address above.
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