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Form U11 - Unemployment Insurance Employer Registration - Montana Department Of Labor And Industry

Mail completed form to:

AGENCY USE ONLY

Employer Number

NAICS

UI Contributions Bureau

PO Box 6339

MONTANA UNEMPLOYMENT INSURANCE

Subject Date

County Code

Helena MT 59604-6339

EMPLOYER REGISTRATION

Or fax to: (406) 444-0629

Questions? Call (406) 444-3834

Remarks

Fill in all spaces that apply to your business.

Toll-free 1-800-550-1513

Instructions are listed on Page 4.

Or visit web site: UieServices.mt.gov

1. Purpose of Registration:

New Employer

Change Legal Name

Change Assumed Business Name (DBA)

Purchased a Business

Changed Business Organization

Update existing Account Information

2. Corporation or Legal Name

Federal Employer ID (FEIN)

3. Business or Trade Name

4. Phone Number

Fax Number

Email Address of Contact Person

5. Mailing Address for Tax Forms (Number & Street or P.O. Box)

City

State

ZIP Code

6. Montana Business Physical Location (Street Address)

City

State

ZIP Code

7. Phone Number

Cell Phone Number

County

8. Mailing Address for Benefit Charge Statements (if different from Tax Form address):

Address

City

State

ZIP Code

9. Mailing Address for UI Claims Separation Questionnaires & Investigations (if different from Tax Form address):

Address

City

State

ZIP Code

10. Type of Organization

Individual

Corporation

Sub-chapter S Corporation

Partnership (Indicate type: general, limited, LLP, etc.): _________________________

Nonprofit Corporation

Government

Limited Liability Company (LLC): If LLC, how have you chosen to be taxed for income tax purposes?

Sole Proprietorship (Schedule C)

Partnership (Form 1065)

Corporation (Form 1120)

S Corporation (Form 1120 S)

Indian Tribe or Wholly-Owned Entity of an Indian Tribe (Name):

In what state was your business originally incorporated or registered?

Date Incorporated:

------ ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ---------- ---------- ---------- ---------- ---------- ---------- -----

Check all that apply.

Domestic /Household

Agriculture

Non-Profit 501 (c)(3)

Fiduciary/Trust

PEO

11. List the owner, partners, or corporate officers. Attach separate sheet if necessary.

Social Security

Telephone &

Name

Home Mailing Address

Title