Form Rds - New Account Registration Form 2010

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NEW ACCOUNT REGISTRATION FORM
RDS- Arizona Department
PO Box 830725 • Birmingham, AL 35283-0725
Phone (866) 940-7660
Fax (205) 423-4099
1 – Legal Business Name____________________________________FEIN/Social Security # ______________________________
2 -
Corporation
Sole Proprietorship
Partnership
Professional Association
Other
3 – Mailing Address: ___________________________________________________________City: _________________________
County: ____________________________________________ State: _____ Zip Code ___________________
4 – Phone Number :_(______)________________________________ Fax: __(______)____________________________________
5 – Owner’s Name___________________________________________________________________________________________
6 – Contact Person _____________________________________________Title: ________________________________________
7 – DBA _________________________________________ Physical Address __________________________________________
Physical City: ________________________Physical County:______________________ State: _____ Zip Code______________
8- Email Address ____________________________________________________________________________________________
9 – (Required Information) Begin Date _________________Description of Business____________________________________
NAIC Code___________________________(See page 2 for a comprehensive listing of NAIC codes.)
Retail Tax (000-017)
Use Tax Purchases (002-029)
Contracting-Contractors (000-015)
Contracting-Owner Builder (000-037)
Commercial Lease (000-013)
Personal Property Lease (000-014)
Telecommunications Services (000-033)
Hotel/Motel (000-025)
Bed Tax (Transient Occupancy Tax (010-100)
Other, please specify ______________________________________________________________________
10 – Indicate the Jurisdiction(s) you will be filing tax in:
(Please see tax rate listing for a current list of all Jurisdictions administered by RDS)
______________________________
__________________________ ________________ _____________________
Print Name
Title
Date
Contact #
______________________________
Signature (Required)
File Your Taxes Online!
Free Voluntary Online Filing and Payment Now Available
Questions? Contact RDS Support at (866) 940-7660 or via email at
Account Registration - RDS 2010

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