New Account Registration Form - Bullhead City, Az - 2010
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2BULLHEAD CITY, AZ
NEW ACCOUNT REGISTRATION FORM
Revenue Discovery Systems (RDS)
PO Box 830725 • Birmingham, AL 35283-0725
Phone (866) 940-7660
Fax (205) 423-4099
1 - FEIN # ___________________________ OR Social Security # _________________________________
2 -
Corporation
Sole Proprietorship
Partnership
Professional Association
Other
3 - Physical Location of Business:
City:___________________ County:_______________ State:___________
4 - Indicate the Type of Tax and Rate You Will be Filing:
Seller’s Use Tax
Sales Tax
Consumer Use Tax
Other, please specify _____________________
General Rate
Automotive Rate
Mfg. Machine Rate
Agricultural Rate
Amusement Rate
Vending
5 – Indicate the Jurisdictions you will be filing tax in:
(Please see tax rate listing for a current list of all Jurisdictions administered by RDS)
_______________________________________________________________________________________________
Bullhead City, AZ
6 – Complete the following information: (All below information is required!)
Taxpayer’s Name:
_________________________________ Contact Person: __________________________
DBA Name:
_________________________________ Title:
___________________________
Mailing Address:
_________________________________ E-Mail Address:_________________________
_________________________________ Street Address: _________________________
City/State/Zip:
_________________________________ City/State/Zip: _________________________
Phone: ________________________________
Fax: _________________________________
Begin Date:
_________________________________
7 – Complete the following information: (REQUIRED)
Description of Business ______________________________________________(e.g.: Used Car Dealer)
NAIC Code_____________________
See page 2 for a comprehensive listing of NAIC codes.
______________________________
__________________________ ________________ _(
) ______________
Signature
Title
Date
Contact #
________
Print Name
File Your Taxes Online!
Free Voluntary Online Filing and Payment Now Available
Questions? Contact RDS Support at (866) 940-7660 or via email at
.
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Bullhead City, AZ - Account Registration - RDS 2010
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