Form Reg-1 - Illinois Business Registration Application
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Illinois Department of Revenue
REG-1
Illinois Business Registration Application
Register faster on-line at tax.illinois.gov. If you are already registered and need to make changes (e.g., adding a location, changing officer
information), call us weekdays between 8 a.m. and 5 p.m. at 217 785-3707.
Step 1: Identify your business or organization
6
Check the organization type that applies to you:
1
Federal employer identification number (FEIN)
Proprietorship
FEIN: ______ - __________________
____ Check if owned by husband and wife or civil union
Proprietorships must provide the Social Security number (SSN)
Partnership
Trust or estate
under which taxes will be filed.
*
*
Corporation
S Corp (Subchapter S Corporation)
SSN: _________ - ______ - ____________
*
Requires President, Secretary, and Treasurer/Comptroller to be identified in Step 2.
2
Legal business name:
Governmental unit
Not-for-profit organization
___________________________________________________
LLC - Corporation
LLC - Partnership
LLC - Single member
3
Doing-business-as (DBA), assumed, or trade name, if different
from Line 2:
____ Check if disregarded
7
Illinois Secretary of State identification number:
___________________________________________________
___ - ___ ___ ___ ___ - ___ ___ ___ - ___
4
Primary or legal business address:
8
Is your business part of a unitary group? ___ Yes
___No
___________________________________________________
If “Yes”, provide the FEIN of your designated agent (the entity
Street address - No PO Box number
Apartment or suite number
responsible for filing your Illinois income tax return):
___________________________________________________
FEIN: ______ - __________________
City
State
ZIP
If you have other locations in Illinois from where you do
9
Identify a contact person regarding your business.
business, complete and attach Schedule REG-1-L.
Name: __________________________Title:______________
5
Mailing address if different from the address above:
Phone: (______) ______ - ________ Ext.: __________
___________________________________________________
In-care-of name
FAX:
(______) ______ - ________
___________________________________________________
Email address: _____________________________________
Street address or PO Box number
Apartment or suite number
___________________________________________________
City
State
ZIP
Step 2: Identify your owners and officers
- If you need to identify more, attach Schedule REG-1-O.
10
Each individual or business (i.e., owner, officer, general partner, trustee, executor, and for limited liability company - manager and member)
must be identified. Identification depends on the organization type you selected in Step 1, Line 6.
Individuals:
(include Social Security number (SSN))
a
d
___________________________________
_________________
___________________________________
_________________
Name
Title
Name
Title
______________________________________________________
______________________________________________________
Home address - No PO Box number
City
State
ZIP
Home address - No PO Box number
City
State
ZIP
____ / ____ / ________
(______) ______ - ________
____ / ____ / ________
(______) ______ - ________
Date of birth
Phone
Date of birth
Phone
_______ - _____ - _________
______
_______ - _____ - _________
______
Ownership percentage:
Ownership percentage:
Social Security number
Social Security number
Businesses:
b
(include federal employer identification number (FEIN))
___________________________________
_________________
Name
Title
a
___________________________________ ____-_____________
Name
FEIN
______________________________________________________
Home address - No PO Box number
City
State
ZIP
______________________________________________________
Legal address
____ / ____ / ________
(______) ______ - ________
Date of birth
Phone
______________________________________________________
City
State
ZIP
_______ - _____ - _________
______
Ownership percentage:
Social Security number
(______) ______ - ________
______
Ownership percentage:
Phone
c
___________________________________
_________________
b
Name
Title
___________________________________ ____-_____________
Name
FEIN
______________________________________________________
Home address - No PO Box number
City
State
ZIP
______________________________________________________
Legal address
____ / ____ / ________
(______) ______ - ________
______________________________________________________
Date of birth
Phone
City
State
ZIP
_______ - _____ - _________
______
Ownership percentage:
(______) ______ - ________
______
Ownership percentage:
Social Security number
Phone
REG-1 (R-07/12) front
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Parent category: Financial