Business Questionnaire Form - City Of Englewood Income Tax Department printable pdf download

City of Englewood Income Tax Department

BUSINESS QUESTIONNAIRE

333 W National Rd, Englewood OH 45322

Phone (937) 836-5106 Fax (937) 771-2891

ENGLEWOOD TAX RATE 1.75%

Email:

tax@englewood.oh.us

Website:

The following information is required to properly establish your City of Englewood income tax account. Please answer

questions fully and return this questionnaire to the address shown above. All information will remain strictly

confidential.

GENERAL INFORMATION

Business Name: _____________________________________________ Federal ID or SSN of Owner: _______________

Type of Business: _____________________________________________________________________

Mailing Address: _________________________________________________________________

Englewood Address (if different): ________________________________________ Phone: _____________________

Date Business began in Englewood: _____/_____/_____

Type of Business Ownership: Sole Proprietor ___ Corporation___ S-Corp ___

Partnership ___LLC ___ Other _____

EMPLOYEE WITHHOLDING INFORMATION

Date Employees began working in Englewood: _____/_____/_____ Number of Employees in Englewood ______

Are you a Monthly or Quarterly withholder? M______ Q ______, Note: If your withholding remittance is more than

$900 per quarter, you must remit on a monthly basis.

Are you a non-resident business withholding for a resident employee only? ___________(Courtesy Withholding)

Date Courtesy Withholding began: _____/_____/_____ Number of Employees withholding for:__________

Address where work is actually performed: _______________________________________________

ACCOUNTING INFORMATION

Accounting Period: Calendar Year_______ or Fiscal Year Ending _____/_____/_____

Contact Person: __________________________________________ Phone: ____________________

Address (if different): ________________________________________________________________

Email: ____________________________________ May we use this email to contact you? Yes ____ No_____

CONTRACTOR AND SUBCONTRACTOR INFORMATION

Do you use Subcontractors? No ______ Yes ______. If you are using Subcontractors, for any portion of your business,

please attach a list of the NAME, ADDRESS and FEDERAL ID number(s) or SOCIAL SECURITY NUMBER(s) of the

COMPANY(IES) or INDIVIDUAL(S) who contract with you.

Print Name: ___________________________ Signature: ______________________________ Title: _________________

Phone Number: ____________________ Email: ____________________________________Date_____/_____/_____

Business Questionnaire Form - City Of Englewood Income Tax Department