Form Tr-370 - Withholding Tax - Registration Application
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4New York State Department of Taxation and Finance
PrompTax
Withholding Tax
Registration Application
You must complete sections I, III, V, and VI of this application. Complete section IV only if you are selecting the ACH Debit
option. Mandatory participants must return completed forms no later than 20 days after the postmark of the official
notification letter. Failure to register within 20 days may result in the imposition of a penalty.
I. Registration data
•
Taxpayer ID:
company name:
DBA
(please print)
Legal company name:
Mailing address:
City and state:
ZIP code:
Please indicate below the individual designated as your contact for the PrompTax Withholding Tax Program. This individual
will receive all material related to PrompTax withholding tax participation, including access code, confidential password,
forms, and payment notices. Do not designate a payroll service vendor as a primary contact person. Your primary
contact person must be a member of your organization. Please make entries in all the fields below (do not write same ).
•
Primary contact person:
(please print)
•
Mailing address:
City and state:
ZIP code:
Telephone number:
•
Fax number:
Email address
(optional)
Please indicate a secondary contact person.
Secondary contact person:
Mailing address:
City and state:
ZIP code:
Telephone number:
Fax number:
Email address
(optional)
(continued)
TR-370
(5/03)
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