Joint Business Registration Form - Wyoming Department Of Workforce Services
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5Wyoming Department of Workforce Services
Joint Business Registration
Return completed form to:
Employer Services
P.O. Box 2760
Casper, WY 82602-2760
For information call:
Unemployment Insurance (307) 235-3217 or Workers’ Compensation (307) 777-6763
1. Legal Business Name:
(Name of the sole owner, partnership, corporation, limited liability company, governmental entity or other)
2. Doing Business As:
(d.b.a. - the name you present to the public, if different than #1)
3.
Addresses
Street or P.O. Box
City
State
Zip
Mailing Address Tax Forms:
Primary Mailing Address:
For Unemployment Claims:
For Workers’ Comp Claims:
4. Work Locations/Physical Locations in Wyoming:
Physical location of all business operations in Wyoming (i.e., office street address; location of a job site; address of employee working out
of his home; sales representative location). List principal business location first and attach additional sheets if necessary.
Phone Number and
In Wyoming
Street Address
Zip
Location Type
(NO P.O. BOXES)
City
County
(i.e., office; home; job site)
a.
Phone:
Type:
b.
Phone:
Type:
Yes
No
Do your Wyoming-based employees also work in other states?
If yes, list those states:
5. Contact Person and Business Telephone Number:
(Individual(s) authorized to provide and receive information about your account)
Contact
Phone Number
Fax Number (optional)
Name
For Unemployment Insurance:
For Workers’ Compensation:
6. Type of Ownership:
(Check only one)
Sole Owner
Partnership
Corporation
Limited Liability Company (LLC)
*** Please complete Question 17, page 5
State where incorporated:
Non-Profit Corporation
Government
Other (describe): ______________________________
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