Form 150-211-159 - Business Contact Change Form
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1Clear Form
Oregon Combined Payroll Tax
To update contact and address information
Business Contact Change Form
Current information will ensure that you receive
tax forms and other important information.
Business name
BIN (Oregon business identification number)
-
Other names (ABN/DBA)
FEIN (Federal employer identification number)
-
Update mailing address
(attach additional sheet if necessary)
Check all that apply:
Billings
Business mail
Payroll tax forms
Address
City
State
Zip
Telephone
Cell
Fax
(
)
(
)
(
)
E-mail
Check here to authorize us to initiate e-mail
Revoke all prior e-mail
addresses
exchange of tax information
Update physical locations
(attach additional sheet if necessary)
#1
#2
Add location
Delete location
Add location
Delete location
Reason
Reason
Street address
Street address
City
State
Zip
City
State
Zip
Is this an employee’s home address?
Is this an employee’s home address?
Update offsite payroll services, accountants or bookkeepers
(attach a Power of Attorney for Authorized Representative)
Name of service, accountant or bookkeeper
Effective date
Contact
Telephone
(
)
Address
City
State
Zip
Fax
E-mail
(
)
Submitted by:
Print name
Title
Telephone
(
)
Signature
Date
Fax to: 503-947-1700
Or mail to: Employment Department, 875 Union St NE Rm 107, Salem OR 97311-0030
150-211-159 (Rev. 04-12)
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Parent category: Financial