Employer Registration Form - West Shore Tax Bureau printable pdf download

Employer Registration Form - West Shore Tax Bureau

WEST SHORE TAX BUREAU

EMPLOYER REGISTRATION FORM

Federal Employer Identification (EIN) ________ - _________________

Corporate Name _____________________________________________

DBA Name _________________________________________________________

Mailing Address _____________________________________________________

City _______________________________________________ State ________ Zip Code ____________

Phone # _______________________ Ext # _________________ Fax # __________________________

Address where business is physically located: (PO Box address is not acceptable). Attach separate listing if

more than one location. If this is a courtesy withholding and employee works from their home, please provide

employee’s home address.

Number and Street _____________________________________________________

City _______________________________________________ State _______ Zip Code ___________

If located in our area of tax collection authority, provide the name of the borough, city or township and school

district in which the business is located:

Boro/City/Twp _________________________________ School District _______________________

Type of Entity: Association _____ Proprietorship _______ Professional Corporation _________

S Corporation ______ Ltd Liability Partnership ______ Ltd Liability Company ______ Foundation _______

Other (Specify) __________

PA Corporation _____ Date of Incorporation _______

Foreign Corporation ______ State of Incorporation _______

Principal type of business in which you are engaged. (please provide a brief description)

____________________________________________________________________________________

Year and quarter business started in our taxing jurisdiction ____________________________________

Contact Persons Name ___________________________ Title _________________________________

Phone # _________________ Ext # _______________ Fax # ______________________

Email Address ___________________________________________

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Employer Registration Form - West Shore Tax Bureau