Ohio Application for Vendor's License to Make Taxable Sales

Application for Vendor's License to Make Taxable Sales
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ST 1
To the County Auditor of

Application for Vendor's
License to Make Taxable Sales

07100100

P.O. Box 182215
Columbus, OH 43218-2215
(888) 405-4089

Vendor license no.

County

Federal Employer Identification Number

Rev. 9/19

(For department use only)

Social Security Number / ITIN

Secretary of State Entity Number

If you file under a cumulative return authority, what is your master number?
1.	

Check type of ownership:
Single member LLC

Sole owner
Partnership
Other (please specify)

Corporation

Nonprofit

LLC

2.

When did you or will you begin providing taxable sales in the state of Ohio? (MM/DD/YY)

3.

Provide NAICS code and state nature of business activity

4.

Legal name

5.

Trade name or DBA

6.

Primary address

LLP

LTD

(For the most current listings, search
NAICS on our Web site at tax.ohio.gov.)

(Corporation, sole owner, partnership, etc.)

Address of corporation, sole owner, partnership, etc.	

Business phone number

City	

State	

Fax number

7.

Mailing address

8.

Business location

9.

How much sales tax do you expect to collect each month?

Secondary phone number

(If different from above)	

City	

Address

City

10. Have you applied for a liquor permit transfer?

Yes

		
Vendor's license number

ZIP code

Less than $200

State	

ZIP code

State

ZIP code

$200 or greater

No

Liquor permit no.

11a.	Have you applied for a new liquor permit?

Yes

No

Date applied for

	 	
11b.	Do
you intend to make nonliquor sales prior to the issuance of your new liquor permit?
Yes
No
	Date business will or did begin
12. If you operate as a corporation, LLC, or partnership, list appropriate names, addresses and identification numbers below.
Title

Name

Street

City	

State

ZIP code

SSN / ITIN / FEIN

Title

Name

Street

City	

State

ZIP code

SSN / ITIN / FEIN

Title

Name

Street

City	

State

ZIP code

SSN / ITIN / FEIN

13. Name, phone number, fax number and e-mail address of individual the department should contact regarding this
account.
Name

Phone number

Fax number	

E-mail address

Note: The county auditor shall not issue a vendor's license until all questions on this application are answered.
Application and payment of the $25 fee must accompany this application.
Date

Signature of applicant

County auditor
Federal Privacy Act Notice

By deputy

Because we require you to provide us with a Social Security number, the Federal Privacy Act of 1974 requires us to inform you that providing us with your Social Security number is mandatory. Ohio
Revised Code sections 5703.05, 5703.057 and 5747.08 authorize us to request this information. We need your Social Security number in order to administer this tax.