Business Questionnaire Form printable pdf download

PALMER TOWNSHIP EARNED INCOME TAX OFFICE

3 WELLER PLACE, P.O. BOX 3039, PALMER PA 18043-3039

PHONE: 610-253-7191

FAX: 610-253-9957

HOURS: MON-FRI 8:30-4:30

BUSINESS QUESTIONNAIRE

Please complete this form and return to the above address, or fax it within ten (10) days. This will allow us

to maintain accurate records to better serve you in the future. Thank you in advance for your cooperation.

PLEASE PRINT

Employer Identification No.________________________ Effective Date of Business_______________

Contact Phone #__________________________________ Fax #________________________________

Name(s) of owner(s): ______________________________________________________

________________________________________________________________________

Trade name (if different from above): _________________________________________

Home address(s): _________________________________________________________

________________________________________________________________________

Physical address of business: ________________________________________________

________________________________________________________________________

Payroll service (if applicable): _______________________________________________

Mailing address where all forms are to be sent: _________________________________

________________________________________________________________________

Check whether employer operates as: Proprietorship___ Partnership___ Corporation___

Other___ (explain)________________________________________________________

Total number of employees: ________________________________________________

Type of business: Retail___ Wholesale___ Manufacturing___ Service___ Other_____

Name and address of previous owner(s): _______________________________________

________________________________________________________________________

I hereby certify that the above information is true and complete.

Date____________ Signature__________________________ Title_________________

Business Questionnaire Form