Form 59507 - Application To Register For Income Tax Withholding And Sales And Use Tax Permit

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North Dakota Office of State Tax Commissioner
Application to Register For
Income Tax Withholding and Sales and Use Tax Permit
FOR OFFICE USE ONLY
(Check both if applicable)
S/U
Application Purpose
New Business
Withholding Tax
W/H
Change in Ownership
Sales and Use Tax
Additional Location
(Please Print)
1. Taxpayer Legal Name
2. Federal Employer I.D. Number (FEIN)
3. Doing Business As Name (if different from line 1)
4. Business Phone
State
City
Zip Code
5. Business Location Address
6. Mailing Address (if different than line 5)
State
Zip Code
City
If returns should be mailed to a different address, indicate below or skip to next section.
8. Business Phone
7. Name of Sales Tax Return Preparer
State
9. Address of Preparer
Zip Code
(Street or PO Box, City)
10. Name of Withhholding Tax Return Preparer
11. Business Phone
State
Zip Code
12. Address of Preparer
(Street or PO Box, City)
13. Beginning date of operations for ND sales/use tax
Month
Day
Year
14. Beginning date of ND Income Tax Withholding
Month
Day
Year
15. Organization Type
S Corporation
Sole Proprietorship
General Partnership
LLC
Corporation
(Only 1 owner allowed
Limited Partnership
LLP
Government
for Question 19)
16. Enter NAICS Code if known
Retailer
Manufacturer
Farm/Ranch
Wholesaler
Contractor
Other _____________
17. Type of Business
18. Business Activity: List the principal products or activities of your firm. Following each item, list the percentage of sales value or receipts
received from the product or activity; i.e., construction of homes 75%, retail sales of furniture 25%.
%
%
Visit North Dakota's New Business Registration site at for general information and registration forms.
Page 1

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